Pharmacy medication verification system

ABSTRACT

A pharmacy medication verification system is particularly useful for verifying medications to be dispensed to hospital patients while minimizing or eliminating verification by a pharmacist. Typically, a technician or robot picks the medications from storage bins in accordance with a medical prescription or stocking order and uses various sensors to ensure that the correct medication was picked and enters a medication container. The system typically provides correct and incorrect medication indicators as well as correct and incorrect entry indicators. Error reports may be generated when appropriate to communicate any relevant errors to the pharmacist, who can then verify that the correct medications are in the container. In one aspect, the containers are in the form of patient drawers which fit within a cart for delivery to hospital rooms. A containment device may be used to secure the drawer or other container during the verification process.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/277,387 filed Nov. 25, 2008, which claimed priority from U.S.Provisional Application Ser. No. 61/004,239 filed Nov. 26, 2007; thedisclosures of which are incorporated herein by reference.

BACKGROUND OF THE INVENTION

1. Technical Field

The present invention relates generally to a system and method forcontrolling the dispensing of pharmaceutical and other medically relateditems. More particularly, the invention relates to a system which isparticularly useful for verifying the accuracy of medicines and otheritems which are to be delivered from a hospital pharmacy to patients inthe hospital.

2. Background Information

The dispensing of the proper medications to patients within a hospitalis a very important aspect of heath care delivery. For several decades,rolling carts have been used to transport medications from a hospital'spharmacy to hospital patients. These carts have multiple drawers eachassigned to an individual patient so that a given patient's medicationsare disposed in a single drawer within one of the carts. As a practicalmatter, there are two sets of drawers one of which is generally kept ata nurses station in the hospital and the other of which is generallykept within the pharmacy to be refilled in preparation for dispensingthe next day's medications. In short, a technician picks or pulls thepertinent medications for given patients in accordance with apatient-specific list of medications and places them in the patientdrawers of the pharmacy carts, which are taken to the nurses stationwhere the drawers of the pharmacy cart are exchanged with those of thenurses cart in preparation for subsequent delivery to hospital patients.The carts thus allow for prescriptions to be filled at the centralizedlocation represented by the pharmacy and transported to decentralizedlocations such as nurses' stations and patient rooms. A pharmacistverifies that the medications within each drawer are the propermedications.

Dispensing cabinets are also commonly used in the medication deliverysystem, including automated dispensing cabinets (commonly known as ADCs)which are configured to help control the proper dispensing and trackingof medications. Dispensing cabinets are typically positioned at or neara nurses station and may, like the carts noted above, be configured fortransport between the centralized pharmacy and decentralized nursesstation for stocking and dispensing, respectively. Such dispensingcabinets have various configurations, but typically include a number ofdrawers each of which are divided into or contain numerous compartmentseach of which serves to hold a specific medication in bulk. Thesecompartments may or may not be removable from the drawer. Some of thesecompartments are configured as open top containers while others includelids which may be opened and closed. One example of such a compartmenthaving a lid is disclosed in U.S. Application Publication 2006/0226167of Broadfield et al., wherein the lidded compartment is commonlyreferred to as a “cubie”. The number of such compartments within adrawer may easily be 20, 30, 40 or more. These compartments are stockedor re-stocked respectively in accordance with an initial stocking orderor re-stocking order which is typically created by a pharmacist or acompany which manufactures or sells the dispensing cabinet. As with thepatient drawers discussed above, a pharmacist will verify that theproper medications are used to fill these compartments during thestocking or re-stocking process. Although this process of verifying thatthe proper medications reach a patient's drawer or the compartments of adispensing cabinet is important, it is also very time consuming.

While there have been a variety of improvements in the verificationsystems for these medications, there is still a need in the art toprovide a more reliable verification system.

BRIEF SUMMARY OF THE INVENTION

The present invention provides a method comprising steps of: determiningwith a medication identification sensor whether a first medication is acorrect or incorrect medication; producing a correct or incorrectmedication indicator respectively depending on whether the firstmedication is the correct or incorrect medication in accordance with thestep of determining; causing entry of the first medication into amedication container after the step of producing; and sensing the entrywith an entry sensor to verify that the first medication has entered thecontainer.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

FIG. 1 is diagrammatic view of the pharmacy medication verificationsystem of the present invention.

FIG. 2 is a perspective view of the patient drawer.

FIG. 2A is a top plan view of the rear section of the patient drawer.

FIG. 3 is a perspective view of the patient drawer containment deviceand related structure.

FIG. 3A is an enlarged top plan view of most of the containment devicewith the transparent box shown in section and showing the plane ofdetection formed by the light beams shown in parallel dashed lines abovethe access opening of the containment device.

FIG. 4 is similar to FIG. 3 and shows a patient drawer prior to beinginserted into the containment device.

FIG. 5 is a top plan view of the front portion of the containment devicewith the transparent box shown in section and the drawer being insertedtherein in an unsecured position.

FIG. 6 is a sectional view taken on line 6-6 of FIG. 5.

FIG. 7 is similar to FIG. 5 and shows the drawer fully inserted andlocked in a secured position.

FIG. 8 is a sectional view taken on line 8-8 of FIG. 7.

FIG. 9 is a perspective view of the containment device showing thepatient drawer inserted therein, the patient identification/informationreader reading the patient identification/information label on thepatient drawer and the fingerprint reader reading the fingerprint of thetechnician or other user of the system.

FIGS. 9A and 9B are diagrammic views showing alternate ways ofdisplaying the patient's medication profile on the computer screen.

FIG. 10 is similar to FIG. 9 with the box shown partially in phantom forclarity and shows the right hand of a technician scanning a pill and thepill being dropped through the light curtain toward the patient drawerwhile the left hand of the technician is pushing the button of thesensor enablement device outside the box.

FIG. 11 is similar to FIG. 10 and shows one of the medication identifierscanners scanning a first label on a medication package.

FIG. 12 is similar to FIG. 11 and shows the scanner scanning a secondlabel on the medication package and the package moving through the lightcurtain into the center compartment of the drawer.

FIG. 13 is a sectional view similar to FIGS. 6 and 8 showing the lockingmechanism in its unlocked position and the patient drawer being removedfrom the containment device.

FIG. 13A is a perspective view of one form of a multi-dose package ofmedications.

FIG. 14 is a perspective view similar to FIGS. 3 and 4 and shows analternate sensor assembly for identifying medications and verifyingtheir entry into the patient drawer.

FIG. 15 is a top plan view similar to FIG. 7 and shows drawer 14 in thesecured position and the operation of the alternate sensor assembly.

FIG. 16 is a perspective view similar to FIG. 3 shown without thetransparent box or enclosure for clarity and shows the patient drawercontainment device with an openable and closeable lid having amedication entry slot which may be covered and uncovered with amotorized cover.

FIG. 17 is an enlarged top plan view primarily illustrating the lid,cover and associated structure.

FIG. 18 is a side elevational view of the containment device of FIGS. 16and 17 taken from the right side.

FIG. 18A is similar to FIG. 18 and shows the use of patient-specifictime specific containers.

FIG. 19 is a sectional view of the device of FIGS. 16-18 lookingforward.

FIG. 20 is a perspective view similar to FIG. 16 showing a medicationbeing identified by one of the medication identifier sensors, the coverbeing automatically opened and the medication being dropped toward themedication entry slot.

FIG. 21 is a sectional view similar to FIG. 19 and illustrates theprocess shown in FIG. 20 and further illustrates the travel of themedication through the entry slot past the entry sensor and into thepatient drawer.

FIG. 22 is a perspective view similar to FIG. 20 and shows a differentmedication in liquid form which is contained within a syringe in apackage which is too large or generally difficult to fit through theslot and in which the medication package is being scanned by one of themedication identifier sensors.

FIG. 23 is a sectional view similar to FIG. 21 and shows the lid beingopened and the medication package with the syringe being placed into thepatient drawer.

FIG. 24 is similar to FIG. 23 and shows the lid being closed again.

FIG. 25 is a perspective view showing a medication in the form of a pillwith a caution label adhered directly thereto.

FIG. 26 is a sectional view similar to FIG. 24 showing an alternateentry sensor which uses a scale for weighing medications as they enterthe drawer.

FIG. 27 is similar to FIG. 18 and shows three patient-specificcontainers removably disposed in the compartments of the patient drawer.

FIG. 28 is a diagrammic view of the hospital rolling cart with onepatient drawer open and one of the patient specific containers removedtherefrom, the on-board or portable scanner scanning the label on theremoved container, and the scanner scanning the patient identificationbracelet of the patient at a bedside location.

FIG. 29 is a front elevational view of a rolling cart which includespatient drawers and a bulk medicine drawer.

FIG. 30 is a perspective view showing a portion of the bulk medicinedrawer with several of the bulk medicine compartments thereof with ascanner scanning one of the compartment labels and an associatedmedication being removed from the associated compartment.

FIG. 31 shows the relationship between FIGS. 31A and 31B, which togetherprovide a flow chart broadly illustrating the medication verificationprocess.

DETAILED DESCRIPTION OF THE INVENTION

The pharmacy medication verification system of the present invention isshown generally at 10 in FIG. 1. System 10 may be used to verify theaccuracy of patient cart fill, that is, to verify the accuracy of themedications 12 which are ultimately placed in a given patient-specificcontainer such as a patient drawer 14, which is subsequently insertedinto a rolling patient cart 16. System 10 may also be used to verify theaccuracy of stocking or re-stocking storage or dispensing cabinets, thatis, to verify that the proper medications are placed in a givenmedication-specific container such as the multiple compartmentstypically found within a given drawer of a medication dispensingcabinet. System 10 is used primarily with prescription or controlledmedications although certain aspects of system 10 are more particularlyintended for use with non-prescription or non-controlled medications, asdiscussed further below. While cart 16 is illustrated here as a standardhospital cart, it is also represents for the purposes of the presentapplication a storage or dispensing cabinet, including an automateddispensing cabinet which may be substantially more complex in variousaspects of its configuration including computer controlled operation forthe purpose of dispensing and tracking medications. Cart 16 is inessence a cabinet having drawers 14 each of which serves as a medicationcontainer and which includes a plurality of compartments as discussedbelow which are analogous to those of a dispensing cabinet.

While a medication container such as patient drawer 14 is disposed in apatient drawer containment device 18, medications 12 are chosen fromvarious storage bins 20 of a storage unit 22 in accordance with acomputer-generated list typically displayed on a screen 24 of a computer26 so that medications 12 may be placed in the drawer 14 withincontainment device 18 with verification of the medications provided byvarious sensors and other control devices which are in electricalcommunication with computer 26. Storage bins 20 may be, for example,drawers which slide in and out, stationary bins or bins which arerevolved on a carrousel in order to access medications 12 therefrom.System 10 includes software or a computer program which is run by acentral processing unit (CPU) of computer 26 for controlling variousaspects of the invention as described further below. Computer 26includes a pair of speakers 28 and an input mechanism such as a keyboard30. It may also include a mouse or various other standard accessoriesusable with the invention. A printer 31 is provided which may be usedfor printing any of the labels, reports and the like which are describedfurther below including any human readable information and any machinereadable data or codes. Printer 31 represents a device which may be usedto print bar codes, and also a device for creating or writing othertypes of machine readable labels. For instance, printer 31 may write toor on a radio frequency identification (RFID) tag or transponder tocreate an RFID tag. Computer 26 is in electrical communication withprinter 31 and various other components of system 10 via electricalwires 32, as described further below.

Once a given patient drawer 14 or other medication container is filledwith the medications 12 which are typically listed on display screen 24,drawer 14 is removed from containment device 18 and replaced in cart 16.The process is then repeated for all of the drawers 14 within cart 16 sothat cart 16 is ready to be removed from the pharmacy to dispense thevarious medications to patients throughout the hospital. To that effect,cart 16 includes a plurality of wheels 34 so that a single personpushing or pulling cart 16 may easily roll it from place to place withinthe hospital. Drawer 14 is usually disposed in cart 16 and is movable ina standard fashion between open and closed positions. Cart 16 includes alocking mechanism which may be locked to secure each drawer 14 in itsclosed position and unlocked to allow the drawer to move between theopen and closed positions, as well as be removed from cart 16 andreplaced therein.

FIG. 2 shows the standard patient drawer 14 in greater detail. Drawer 14is sufficiently small so that a single individual can easily supportdrawer 14 with one or two hands and thus manually transport andotherwise manipulate it to position it as desired. Drawer 14 isgenerally rectangular and thus includes a rectangular bottom wall 36,first and second rectangular sidewalls 38 and 40 connected to andextending upwardly from bottom wall 36, and front and back rectangularwalls 42 and 44 connected to and extending upwardly from bottom wall 36and extending respectively from first wall 38 to second wall 40. Drawer14 has a top 35 which represents the uppermost edge of the various walls38, 40, 42 and 44. Drawer 14 also has a bottom 37 which is the bottomsurface of bottom wall 36 and/or walls 38, 40, 42 and 44. Top and bottom35 and 37 define therebetween a height H1 of drawer 14.

First and second dividers 46 and 48 are typically disposed within drawer14 parallel to front and rear walls 42 and 44 so that front wall 42 andfirst divider 46 define therebetween a first or front upwardly openingcompartment 50, first and second dividers 46 and 48 define therebetweena second or intermediate upwardly opening compartment 52, and seconddivider 48 and back wall 44 define therebetween a third or rear upwardlyopening compartment 54. Drawer 14 defines a medication compartment 49extending from front wall 42 to rear wall 44, from sidewall 38 tosidewall 40 and from bottom wall 36 upwardly to the top 35 of each ofwalls 38, 40, 42 and 44. Thus, compartment 49 has a length L1 extendingfrom front wall 42 to rear wall 44 and a substantially constant innerwidth W1 extending from the inner surface of sidewall 38 to the innersurface of sidewall 40. The outer surfaces of side walls 38 and 40define therebetween and width W2 representing the widest portion ofdrawer 14 extending in the axial direction and wherein width W2 issubstantially constant from front wall 42 to rear wall 44. Frontcompartment 50 has a length L2 extending from front wall 42 to firstdivider 46. Likewise, compartment 52 has a length L3 extending fromfirst divider 46 to second divider 48 and rear compartment 54 has alength L4 extending from second divider 48 to rear wall 44 so thatlength L1 of compartment 49 is substantially equal to the total oflength L2, length L3 and length L4. Width W1 thus also represents thewidth of each of compartments 50, 52 and 54.

Compartments 50, 52 and 54 are respectively associated with threemedication-dispensing or medication administration time periods within a24-hour day, as indicated by time period labels 55A-C. Thus, medications12 which are placed in front compartment 50 are to be dispensed to thepatient during a first time period, while medications 12 placed incompartments 52 and 54 are to be dispensed to the patient respectivelyduring subsequent second and third time periods. Labels 55A-C show anexample of the respective time periods in military time nomenclature,with the first period being 0700-0959 (7:00 AM-9:59 AM) or about threehours long, the second period being 1000-1859 (10:00 AM-6:59 PM) orabout nine hours long, and the third period being 1900-0659 (7:00PM-6:59 PM) or about twelve hours long, with the three time periods thustotaling a 24-hour duration. Drawer 14 further includes a handle 56connected to and extending forward from front wall 42 so that drawer 14may be manually removed from and replaced in cart 16 and containmentdevice 18. A patient identification/information label 58 is mounted onthe front of drawer 14 on handle 56 and includes the patient's name inhuman readable printed text form and a machine readable identifier 60associated with the patient and/or one or more medications. Identifier60 may be a bar code, a radio frequency identification (RFID) tag or anyother suitable machine readable identifier. Drawer 14 further includes alock engageable structure 62 which is connected to and extendsrearwardly from adjacent back wall 44. Structure 62 includes four flatgenerally vertical fins 64 and first and second crossbars 66 and 68which extend between and are connected to each of fins 64. Crossbars 66and 68 each include a cam surface 70 which tapers downwardly andrearwardly, as shown in FIGS. 6 and 8. Crossbar 66 includes a front orforward facing locking surface 72. Second crossbar 68 includes arearmost stop engagement surface 73.

With reference to FIG. 3, containment device 18 and the relatedstructure of system 10 is described in greater detail. Containmentdevice 18 and the associated structure thereof have a front 75 and arear 77 defining therebetween a longitudinal direction of the structure,first and second sides 79 and 81 defining therebetween an axialdirection of the structure, a top 83 and a bottom 85. Device 18 includesa rigid bottom wall 74 having a lower surface typically seated on atabletop or counter at a height suitable for a technician or otheroperator of system 10, typically while standing, to manually operatedevice 18 and the related structure. Bottom wall 74 has an upper surface76 which is substantially horizontal and serves as a sliding surfacewhich drawer 14 slidably engages upon insertion and removal of drawer 14into and out of device 18. First and second parallel longitudinallyextending rigid guide walls 78 and 80 are rigidly connected to bottomwall 74 and extend upwardly therefrom in a vertical manner. Guide walls78 and 80 are shown in the exemplary embodiment as upwardly extendinglegs of respective angles. Walls 78 and 80 have respective inner guidesurfaces 82 and 84 which face one another and are slidably engaged bydrawer 14 upon insertion and removal. Guide wall 78 has a front end 86which is positioned forward of a front end 88 of second guide wall 80,typically a few inches, to facilitate insertion of drawer 14 into adrawer-receiving space 90 defined between guide walls 78 and 80 andbounded by upper surface 76 of bottom 74. Inner surfaces 82 and 84 ofguide walls 78 and 80 define therebetween a width W3 (FIG. 4) which isslightly larger than width W2 of drawer 14 so that drawer 14 may slidealong upper surface 76 of bottom wall 74 with inner surfaces 82 and 84serving as guides which slidably engage the outer surfaces of sidewalls38 and 40 of drawer 14 and also serve to limit the axial movement ofdrawer 14 when positioned within drawer-receiving space 90. A rigid rearstop or stop wall 92 (FIGS. 6, 8) having a forward facing stop surface94 is rigidly connected to and extends upwardly from bottom wall 74adjacent its rear end and bounds the rear of drawer-receiving space 90.In the exemplary embodiment, stop wall 92 is an upwardly extending legof an angle with the other leg secured to wall 74.

Containment device 18 (FIG. 3) further includes a rigid transparentelevated wall 96 which is substantially horizontal and spaced upwardlyfrom bottom wall 74 by four supports or posts 98A-D with posts 98A and Bserving as axially spaced front posts and posts 98C and D (FIGS. 6, 8)serving as axially spaced rear posts. Elevated wall 96 is substantiallyhorizontal and thus parallel to bottom wall 74. A rectangular medicationaccess opening 100 has been cut into or otherwise formed in flat wall 96which thus includes a front wall section 102, a rear wall section 104and first and second sidewall sections 106 and 108 each of which is flatand bounds access opening 100. Elevated wall 96 has a lower surface 97so that lower surface 97 and upper surface 76 of bottom wall 74 definetherebetween a height H2 (FIG. 8) which is only slightly greater thanheight H1 of drawer 14. Lower surface 97 bounds the top ofdrawer-receiving space 90 so that height H2 also represents the heightof space 90. Thus, the space between the top of drawer 14 and lowersurface 97 when drawer 14 is inserted into space 90 is sufficient toallow drawer 14 to easily slide into and out of space 90 while lowersurface 97 serves as a stop to upward movement of drawer 14 whichtypically substantially eliminates such upward movement. While upwardmovement of drawer 14 within space 90 is permissible to some extent, itis preferred that this is kept to a minimum. In addition, it ispreferred that the distance between the top of drawer 14 and lowersurface 97 is too small to allow for the passage of medication 12therethrough, thus eliminating the possibility of medication 12 notentering drawer 14 during the drawer fill procedure due to such passage.

As shown in FIG. 7, front wall section 102 has a straight axiallyextending rearward facing surface 103 which bounds access opening 100.Likewise, rear wall section 104 has a straight axially extending forwardfacing edge or surface 105 which is parallel to surface 103 and alsobounds access opening 100. Similarly, side walls sections 106 and 108respectively have first and second lateral edges or surfaces 107 and 109which are parallel to one another and extend longitudinallyperpendicular to surfaces 103 and 105 and bound access opening 100.Thus, edges or surfaces 103 and 105 face one another, as do edges orsurfaces 107 and 109 to define the rectangular shape of opening 100.Surfaces 103 and 105 define therebetween a length L5 of access opening100 which is approximately the same as length L1 of compartment 49 ofdrawer 14. Length L5 may be somewhat shorter than length L1 as long asfront and rear wall sections 102 and 104 do not interfere with thedropping of medications 12 into compartments 50 and 54 to anobjectionable degree. Similarly, length L5 may be somewhat longer thanlength L1, but should not be longer to the degree that medications 12may be dropped outside of these compartments between a respective one ofedges 103, 105, 107, 109 and a corresponding vertical wall of drawer 14when drawer 14 is secured within drawer-receiving space 90 in its fillposition. Edges or surfaces 107 and 109 define therebetween a width W4of access opening 100 which is approximately the same as width W1 ofcompartment 49 of drawer 14. Due to the relatively thin walls of drawer14, width W2 thereof is only slightly larger than width W1 and thuswidth W4 is also approximately the same as width W2. As discussed withthe possible variation of length L5, width W4 may also be somewhatlarger or somewhat less than width W1 or width W2 in accordance with thesame rationale.

System 10 further includes a type of medication sensor referred toherein as an entry sensor or drop sensor typically in the form of apresence sensing device such as a light curtain 110 comprising alight-transmitting mechanism 112 and a light receiving mechanism 114each in the form of an elongated rectangular bar secured at either endto elevated wall 96 by respective mounting brackets 116 in the form ofshort L-shaped angles. Transmitter 112 is in electrical communicationwith a source of electric power (not shown) via a wire 130, which alsomay be in electrical communication with computer 26. Likewise, receiver114 is in electrical communication with an electric power source andcomputer 26 via a wire 132. Transmitter 112 includes an array 118 oflight-transmitting elements typically in the form of light emittingdiodes (LEDs) and an array 120 of light-receiving elements typically inthe form of phototransistors or photodiodes. Each of thelight-transmitting elements or LEDs of array 118 projects a light beamto corresponding receiving elements of array 120 so that a plurality ofparallel light beams 122 (FIG. 3A) is transmitted from array 118 toarray 120 to provide a sensing field also commonly referred to as aplane of detection. Each of arrays 118 and 120 has a lengthapproximately the same as length L5 of access opening 100 so that theplane of detection or sensing field produced by light beams 122substantially covers access opening 100 at a height just above elevatedwall 96. Light beams 122 are positioned close enough to one another toensure that any medication 12 (or other item of equal or greaterdimensions) dropped through opening 100 into space 90 and into drawer 14when disposed in space 90 will interrupt one or more of beams 122 sothat the medication is detected as it passes in its entirety through theplane of detection defined by beams 122, from one side of said planethere above to the other side of said plane there below.

Typically, the LEDs emit pulses of invisible infrared light whenenergized by the timing and logic circuitry of the light curtain so thatthe light pulses are both sequenced and modulated. Sequenced here meansthat one LED is energized after another while modulated means that thelight is pulsed at a specific frequency. Thus, the phototransistors orphotodiodes and supporting circuitry in photoelectric receiver 114 areconfigured to detect only the specific pulse and frequency designatedfor the given phototransistor or photodiode, which helps eliminate theinterfering acceptance of ambient light or light from other sources. Ifdesired, array 120 may be divided into smaller arrays or sub arrays suchas the three sub arrays indicated at 124, 126 and 128 in FIG. 3A, thesub arrays thus serving as three independent entry sensors. Sub arrays124, 126 and 128 are aligned to respectively correspond to compartments50, 52 and 54 of drawer 14 when in its secured filling position withinspace 90 of containment device 18. More particularly, the length of eachsub array is typically approximately equal to that of the respectivecompartment. Thus, any medication 12 or other items which pass throughthe plane defined by the beams 122 of sub array 124 would produce asignal indicating that medication 12 passed into compartment 50.Likewise, sub arrays 126 and 128 would allow for detection ofmedications 12 passing into compartments 52 and 54 respectively. Array120 may also be configured without sub arrays so that the dropping ofthe medication 12 would simply indicate that the medication passed intodrawer 14 without indicating the specific compartment thereof. Thus, thelogic circuitry of light curtain 110 and/or the computer program run oncomputer 26 may be configured for either alternative.

While light curtain 110 has been described as utilizing a lighttransmitter on one side of access opening 110 and a photoelectricreceiver on the other side, typically known as an opposed arrangement,it may also represent alternative arrangements. For instance, aretroreflective arrangement may be utilized in which the receivingelements described in array 120 are located instead within the housingof light transmitter 112 and array 120 is replaced by a reflector ormirror which reflects the light beams emitted from the transmittingelements back to the receiving elements. In the opposed arrangement andthe retroreflective arrangement an opaque object is sensed when one ormore beams 122 is interrupted and thus fails to reach the receivingelement. While the opposed arrangement or retroreflective arrangementare preferred, is it also possible to use a proximity-sensingarrangement in which the transmitted beams must reflect off of theobject such as medication 12 in order to reach the receiving elements,which may or may not be positioned adjacent the transmitting elements.In this mode, an object is detected when the receiving elements sensethe beam reflected from the object instead of when it fails to sense alight transmission.

With reference to FIG. 3 once again, a cord housing or channel 134 issecured to bottom wall 74 and extends longitudinally along first side 79to provide a housing through which electrical wires 136 extend. A wallor plate 138 is connected at the top of housing 134 and the top ofelevated wall 96 along sidewall section 106 and extends longitudinallyfrom adjacent front 75 to adjacent rear 77. A patient identifier andinformation access sensor 140 is secured to bottom wall 74 adjacentplate 138 via an L-shaped mounting bracket 142 and a pair of posts 144(only one shown). Sensor 140 is in electrical communication withcomputer 26 and may be a bar code scanner, an RFID reader, a camera orother suitable device for reading a patient identifier or informationcode or label such as identifier 60 or the like. A manually engageablesensor enablement device 146 is mounted on plate 138 and includes amanually depressible button 148. Button 148 is movable between anon-depressed inactivated position and a depressed activated position,and is spring biased to the non-depressed position. Device 146 typicallyuses an electrical switch so that movement of button 148 between itsdepressed and non-depressed positions changes the state of an electriccircuit from closed to open or vice versa. A fingerprint reader 150 ismounted on plate 138 adjacent device 146 and includes a finger pad 152capable of reading a fingerprint. Sensor enablement device 146 andfingerprint reader 150 are in electrical communication with computer 26.Three medication identification sensors 154A, 154B and 154C are mountedon bottom wall 74 via respective support legs 156 and represent anothertype of medication sensor. Each sensor 154 is in electricalcommunication with computer 26 via a respective wire 158. Sensors 154A,B and C are adjacent and spaced from one another in the longitudinaldirection and are spaced upwardly from transmitter 112 to face generallytoward the space above access opening 100 and the sensing field of lightbeams 122 when activated. Sensors 154 and 140 are part of a medicationsensor assembly of system 10. A locking mechanism 160 is mounted on rearwall section 104 of elevated wall 96 via a mounting plate 162 and isdescribed in greater detail further below.

A transparent box 164 is provided and includes five substantially flattransparent walls, namely front wall 166, rear wall 168, first andsecond sidewalls 170 and 172 and top wall 174, the latter of which issubstantially horizontal while the remaining walls extend upwardly andare typically substantially vertical. Box 164 is secured to plate 138and bottom wall 74 via a plurality of mounting brackets 176 which areshown in the form of L-shaped angles (only three shown). Front and rearwalls 166 and 168 extend upwardly from adjacent or in abutment withelevated wall 96 and plate 138 to connect to top wall 174. Firstsidewall 170 extends upwardly from adjacent or in abutment with housing134 to connect to top wall 174. Second sidewall 172 extends upwardlyfrom adjacent from bottom wall 74 adjacent second sidewall section 108to connect to top wall 174. A generally oval manual access opening 178is formed in second sidewall 172 and communicates with an interiorchamber 180 defined by the various walls of box 164 to provide manualaccess between interior chamber 180 and the space external to box 164.Sidewall 172 thus serves as an access wall so that a technician or otheruser of system 10 may insert his or her hand from outside box 164 intointerior chamber 180. Front wall 166 serves as a barricade wall toprevent the technician or other user of the system from inadvertentlymoving the other hand, namely the hand not inserted through accessopening 178, from a position in the external space outside of wall 166to the interior chamber 180 on the other side of wall 166. Top wall 174serves as a cover wall which helps prevent various items fromaccidentally being dropped into interior chamber 180 and into drawer 14when disposed in containment device 18. The remaining walls of box 164also help prevent inadvertent insertion of various items into drawer 14.Box 164 is typically formed of Plexiglas® or another transparentmaterial so that the transparency allows users to see what they aredoing within box 164 during the process described below, for instance toview a medication, a hand and other items within chamber 180 through oneof the walls of box 164.

Locking mechanism 160 is now described in further detail in reference toFIG. 6. Locking mechanism 160 is preferably an electromagnetic lockingmechanism and thus includes a solenoid disposed within a housing 182. Aplunger 184 is moveably mounted on housing 182 and extends through abottom opening from partially within the housing to partially outsidethe housing. Plunger 184 has a rounded or dome shaped bottom whichserves as a cam surface to facilitate its upward movement as describedfurther below. A threaded portion 186 is rigidly connected to andextends upwardly from housing 182 and is threadedly engaged by a nut 188to secure the upper portion of housing 182 within a larger bore 190formed through rear wall section 104 of elevated wall 96 and to securethreaded portion 186 within a smaller through bore 192 formed inmounting plate 162. The solenoid of locking mechanism 116 is inelectrical communication with an electric power source and computer 26via a wire or wires 194. Plunger 194 is spring biased to its loweredposition shown in FIG. 6 and moveable to its raised position shown inFIG. 13 when the solenoid is electrically activated. A manual key (notshown) may be provided to unlock mechanism 160 if there is a powerfailure or the solenoid fails.

The operation of system 10 is now described with reference to FIGS. 1and 4-13. Before the technician begins filling the patient drawers 14,the pharmacist will have made or verified an association between eachdrug or medication 12 and the scan code or identifier 198 which appliesto that medication so that the identifier 198 for a given medication 12is recognized by and accurately specifies the given medication 12 withinsystem 10 and the given pharmacy and hospital computer systems whereapplicable. To do this, the pharmacist may scan the identifier 198 of agiven medication 12, identify the medication and assign the identifier198 to the given medication 12. The computer program is thus configuredfor the pharmacist to make this association via an input mechanism ofcomputer 26. System 10 is configured to use a biological identification(bio-ID) mechanism such as fingerprint reader 150 in order to trackwhich pharmacist makes or verifies the association for a givenmedication 12. Thus, the computer program is configured to require thatthe pharmacist enter his or her bio-ID when making or verifying theassociation so that the computer program makes an automatic log of thepharmacist making the association. The record of who made theassociation may include only the last association made or allassociations for a given medication. While system 10 providesfingerprint reader 150 to serve as the bio-ID mechanism, a retinascanner for making a positive identification of the pharmacist byscanning the retina of his or her eye may be used for this purposeamongst other known bio-ID mechanisms.

While the above description illustrates that the pharmacist assigns aspecific identifier 198 to a given medication 12, the associationbetween the medication and its identifier may be made otherwise andverified by the pharmacist. For example, a manufacturer or wholesaler ofthe medications, or another company, may produce a label with a bar codeor the like having an identifier which is associated with the specificmedication before it ever reaches the pharmacy. This identifier may bethe same identifier which is used by system 10 and a given pharmacy suchthat the pharmacist does not need to make the association between themedication and its identifier, but merely to verify that the associationis correct. The computer program of system 10 is thus configured for thepharmacist to scan the identifier and make an input into the systemindicating that the medication identifier has been verified as beingcorrect. Alternately, instead of one of the entities noted aboveproducing the label with its identifier which is subsequently deliveredto the pharmacy, the entity may provide a data feed of the requiredinformation to generate this label. Regardless of the specific process,the association between the medication and its identifier is to beverified by the pharmacist prior to using the given medication forfilling a given medication container such as patient drawer 14 which isassigned to a specific patient or a compartment which is part of astorage or dispensing cabinet and thus assigned to a specificmedication.

The technician or other user of system 10 will remove one of patientdrawers 14 from cart 16 in preparation for filling the drawer with agiven patient's medications. As shown in FIG. 4, the lock engageablestructure 62 at the rear of drawer 14 faces rearwardly as drawer 14 ismoved toward the entrance opening of drawer receiving space 90 ofcontainment device 18. FIG. 4 also illustrates the advantage of firstguide wall 178 extending forward of second guide wall 80 by illustratingthat drawer 14 may be slid on surface 76 of wall 74 or moved axially asindicated at Arrow B in a direction generally away from second wall 80and toward first wall 78 in order to first engage surface 82 of firstguide wall 78 forward of front 88 of second guide wall 80 and thus priorto the insertion of sidewall 40 of drawer 14 past the front of secondguide wall 80. This configuration thus allows for drawer 14 to be easilyaligned with drawer-receiving space 90 to facilitate insertion of drawer14 therein. FIG. 5 shows that most of drawer 14 has slid into drawerreceiving space 90 as indicated at Arrow C so that bottom 37 (FIG. 4)drawer 14 slidably engages upper surface 76 of bottom wall 74 whilesidewalls 38 and 40 of drawer 12 respectively slidably engage innersurfaces 82 and 84 of guide walls 78 and 80. FIG. 6 illustrates aposition of drawer 14 which is slid further rearwardly than that shownin FIG. 5 so that cam surface 70 of second crossbar 68 approaches thedome shaped outer surface of plunger 184 prior to being locked into asecured position by locking mechanism 160. FIG. 6 also shows in dashedlines cam surface 70 slidably engaging plunger 184 and forcing itupwardly as drawer 14 continues to move further rearwardly. Oncecrossbar 68 passes behind plunger 184, plunger 184 automatically movesdownward in response to its spring bias. Subsequently, cam surface 70 offirst crossbar 66 similarly engages the curved surface of plunger 184 toforce it upwardly, then moves behind plunger 184 which once againsprings downwardly into the locked positions of FIGS. 7 and 8. As shownin FIG. 8, when drawer 14 is in its secured fill position, the rearsurface of plunger 184 engages locking surface 72 of crossbar 66 toprovide an interference so that drawer 14 may not be withdrawn forwardfrom within drawer receiving space 90 unless locking mechanism 160 isunlocked. Rearmost surface 73 engages stop surface 94 to provide aninterference which prevents rearward movement of drawer 14. Drawer 14 inits secured position is substantially immobilized or stationary.

The movement of plunger 184 in response to the insertion of drawer 14into its secured position may create a signal from locking mechanism 160to computer 26 indicating that drawer 14 is in its secured position,which may cause the computer program to respond in various ways. Forinstance, the computer program at this time may activate the dropsensor, which could mean that light beams 122 are turned on or that thecomputer program will begin checking for interruption of the sensingfield of the drop sensor if the sensing field is already activated. Thecomputer program may also require at this time an empty drawer checkand/or a drop area check. The empty drawer check would require thatdrawer 14 be checked to determine whether it is empty or not prior toits being filled in accordance with the computer generated list for agiven patient in accordance with a medical prescription. To that effect,the computer program is typically configured to require the technicianto respond with an answer of either “yes” or “no” to an inquiry orprompt (FIG. 9A) displayed on screen 24 as to whether the drawer isempty. The computer program will allow the verified filling of drawer 14only if the answer is “yes”. If the answer is “no”, the computer willunlock locking mechanism 160 and will not continue with the verifiedfilling of the drawer until the technician answers “yes”. The technicianchecks the drawer and may manually remove items therefrom to ensure thatthe drawer is empty before proceeding. Alternately, device 18 may beconfigured to mechanically turn the drawer over to empty said drawer.The drop area check noted above may similarly require that thetechnician answer an inquiry or prompt (FIG. 9A) as to whether the droparea is clear of medications or other objects which may interfere withthe process. For instance, such medications or objects may haveinadvertently been positioned atop elevated wall 96, transmitter 112,and receiver 114 or within space 90. Ensuring that this area is clearedmay be accomplished manually by the technician or by an automatedmechanical clearing device (not shown).

As shown in FIG. 7, drawer 14 in the secured or locked position ispositioned so that compartments 50, 52 and 54 are respectively alignedwith and associated with medication identification sensors 154A, B andC. Likewise, sub arrays 124, 126 and 128 when used are respectivelyaligned with compartments 50, 52 and 54 of drawer 14 with first andsecond dividers 46 and 48 respectively aligned with the boundary betweensub arrays 124 and 126 and the boundary between sub arrays 126 and 128.Thus, when transmitter 112 is activated to produce light beams 122 (FIG.3A), the receiving elements of sub array 124 and the light beams 122received thereby are associated with compartment 50, while the receivingelements and the associated light beams of sub array 126 are associatedwith compartment 52 and the receiving elements and light beamsassociated with sub array 128 are associated with compartment 54.

As shown in FIG. 9, the technician, pharmacist or other operator ofsystem 10 may place a finger 196 on finger pad 152 (Arrow D) in order toidentify whether the person is authorized to use system 10 although theuser may log on to computer 26 in a standard manner which may includethe use of a password. In addition, fingerprint reader 150 or anotherbio-ID mechanism provides a positive identification of the particularuser of system 10. If the fingerprint reader or other mechanismidentifies an authorized user, the computer program run by computer 26proceeds with the rest of the process and also records the user'sidentification so that it can be determined subsequently who filled thedrawer or was responsible for doing so. FIG. 9 also shows that oncedrawer 14 is secured within containment device 18, patientidentification and information access sensor 140 reads (dashed lines)identifier 60 on label 58 to identify the patient and/or medicationassociated with the given drawer 14. The patient identification iscommunicated to computer 26 whereby the logic circuitry of the computerprogram accesses from the computer database pertinent information aboutthat patient including all the medications 12 that are to be dispensedto the patient during a given day in accordance with a medicalprescription. The prescription and thus database may specify only asingle unit dose of a medication or multiple unit doses, and may or maynot include different medication types. Where system 10 is being used tofill the drawer or other medication container of a storage cabinet ordispensing cabinet for the purpose of stocking or re-stocking,identifier 60 would be associated with a specific medication which doesnot include a specific patient. In this case, identifier 60 may thussignal the computer program such that it retrieves from the database thespecification for a single medication type along with the number whichis needed to stock or re-stock the medication container of the cabinet.The reading of identifier 60 may also trigger the response from thecomputer program described above as having been triggered by movement ofplunger 184, that is, activation of the drop sensor and so forth.

The patient's daily medical prescription or medication profile istypically displayed (FIGS. 9A-9B) on screen 24 so that the techniciancan read the various medications to fill drawer 14. The medication listmay specify one or more medications and may be displayed a singlemedication at a time or may be displayed with a plurality of medicationswherein, for instance, one medication at a time is highlighted. Theformer scenario is illustrated in FIG. 9A with an upper and lowercomputer in which the upper computer 26 illustrates the single listingof the first medication MED-1 on display screen 24 and the lowercomputer 26 illustrates a subsequent display of a second medicationMED-2 on display screen 24. The latter scenario is illustrated in FIG.9B which shows the medication profile including MED-1 through MED-4 withMED-1 being initially highlighted as illustrated by the solid linerectangle around MED-1 and MED-2 subsequently being highlighted by thedashed line rectangle around MED-2. In the highlighting version, onlyone medication is highlighted at a time. The technician follows themedication list on screen 24 one medication at a time. Thus, thetechnician will read either a single listed medication on the screen(FIG. 9A) or a medication which is highlighted (FIG. 9B) and thenretrieve that medication 12 from one of storage bins 20 (FIG. 1).

The medication profile on screen 24 also indicates the location of themedication to be retrieved and the correct time period during which themedication is to be dispensed to the patient so that the technicianknows from which bin to retrieve the medication, which of sensors 154 touse and which of compartments 50, 52, and 54 is to receive themedication. This is illustrated in FIG. 9A wherein the upper computer 26displays on its screen 24 “MED-1 LOC-1 TIME-1” such that MED-1 is in afirst column, LOC-1 is in a second column and TIME-1 is in a thirdcolumn all aligned on a common line or row and wherein LOC-1 representsthe location of MED-1 and TIME-1 represents the time period during whichthe medication MED-1 is to be dispensed or administered to the patient.The lower computer 26 of FIG. 9A shows a similar setup in which LOC-2and TIME-2 respectively represent the location of medication MED-2 andthe time period during which it is to be dispensed or administered. Thisis similarly illustrated in FIG. 9B. While TIME-1 and TIME-2 and soforth may specifically spell out the time period for administration ofthe associated medication, it also may represent in the alternative orin combination one of sensors 154 and/or one of compartments 50, 52 and54. For example, instead of listing the time on display screen 24, oneof sensors 154 may be specified so that the technician knows to use thatsensor in scanning the corresponding medication and to drop themedication into the compartment 50, 52 or 54 associated with the givensensor 154. Likewise, one of compartments 50, 52 and 54 may be indicatedon display screen 24 instead of or in combination with an indication ofwhich sensor 154 to use and the associated time period. Another optionwhich may be used alternately or in combination with these concepts isto provide an indicator on or adjacent the respective sensors 154 and/orcompartments 50, 52 and 54 to indicate to which of these sensors andcompartments is to be used. For instance, the computer program may beconfigured to turn on a light adjacent the appropriate one of sensors154 and/or one of the compartments of drawer 14 when a given medicationis listed on screen 24 in order to direct the technician to use theproper scanner and medication compartment for the displayed orhighlighted medication.

In the above illustration, screen 24 provides a visible communication inthe form of text or other symbols which may be read by a technician tocommunicate for example the requirement for an empty drawer check or adrop area check along with the specification of a given medication, itsstorage location, its dispensing time and/or which sensors are to beused to scan the medication and which compartment the medication is toenter. Alternately or in combination, other prompts or indicators may beprovided to communicate the need to perform the given tasks or identifythe medication, location and so forth. For instance, the computerprogram may be configured to cause audible messages to sound throughspeakers 28 or the like. Such an audible prompt, indicator orcommunication may simply be in the form of a recorded spoken phrase orsentence such as “Drawer empty?”; “Is the drop area clear?”; “Medication1, location 1, time 1”; “Retrieve medication 1 from location 1, scan itwith scanner 1 and drop it in compartment 1”; or other like messages. Asnoted above, such audible messages may be used in combination with thevisible prompts on the computer screen or may be used without suchvisible prompts or messages.

Once the appropriate medication—most typically as a unit dose—has beenretrieved from its storage location, the technician will position themedication such as a pill shown at 12A in FIG. 10 adjacent themedication identification sensor 154 associated with the time periodindicated in the patient profile so that a medication identifier 198 onmedication 12A may be scanned or read (dashed lines) by the appropriatesensor, shown in FIG. 10 as sensor 154A. Identifier 198 is typically abar code or another suitable machine readable identifier which may beconnected to the medication directly (FIGS. 10, 15) or indirectly on itspackaging or the like (FIGS. 11, 21, 25). Sensor 154A sends a signal tothe CPU of computer 26 so that the computer program can determinewhether the medication 12A is the correct medication in accordance withthe patient profile. “Pick sensors”, such as light curtains, may also bepositioned adjacent respective pick locations like bins 20 to indicatefrom what location the scanned medication came or was “picked”, forinstance, which assigned pick location or bin 20, or another locationwhich was not assigned. If medication 12A is the correct medication, acorrect or good audible scan tone is sounded via speakers 28 (FIG. 1) toindicate that medication 12A is the correct medication. If not, anincorrect or bad audible scan tone is sounded via speakers 28 toindicate that medication 12A is the incorrect medication. Thus, the goodand bad scan tones are distinct from one another so that the techniciancan easily discern between the two.

The correct and incorrect scan tones are but one form of correct andincorrect medication indicators which may be used in the presentinvention. Other such indicators may be used alternately or incombination with these audible tones, such as light or another visibleindicator. For example, a correct medication scan may be indicated by agreen light while a bad medication scan may be indicated by a red light,or a correct scan may be indicated by a flashing light and an incorrectscan may be indicated by a steady light. Similarly, one or more smalldisplay screens associated with sensors 154 could be controlled todisplay correct and incorrect indicators without illuminating a lightsource. For instance, a liquid crystal display of black lettering or thelike may be used wherein the correct indicator might for example beindicated by “Yes” or “Y” while the incorrect indicator might bedisplayed as “No” or “N”. Correct and incorrect indicators might alsoutilize movement of a pointer or flag, wherein, for example, the pointercan move in one direction to provide a correct indicator and in anotherdirection to provide an incorrect indicator, or wherein two differentcolors may be used respectively as said indicators. Any suitableindicator may be used for this purpose.

If medication 12A is the correct medication, the technician then dropsmedication 12A (Arrow E) into the associated compartment 50 of drawer14. As medication 12A drops downwardly, it interrupts typically for asmall fraction of a second one or more of the light beams as indicatedat 122A in FIG. 10 so that said light beams momentarily do not passthrough the region indicated at 200 to the corresponding photoelectricsensors of receiving unit 114. This interruption of one or more of thelight beams causes a signal to be sent from receiving unit 114 tocomputer 26 indicating that medication 12A has been dropped through thesensing field and into compartment 50. The computer program is set up torequire that medication 12A be dropped through the plane of detection oflight beams 122 within a relatively short period after being scanned bysensor 154A. Typically, it only takes one or two seconds from the timethat the technician scans the medication and hears a good drop toneuntil the medication passes through the plane of detection of the lightbeams. Thus, the computer is typically programmed for such a shortperiod although somewhat larger allowance is usually given such as up to3, 4 or 5 seconds or possibly a little bit more although usually notmore than 6-10 seconds and typically not more than 5 seconds. If aproper or good drop of medication 12A occurs, a correct or good droptone is sounded via speakers 28 to that effect. A good drop tone isnormally sounded for a drop which is associated with a good scan viasensor 154, which thus means that medication 12A is the correctmedication and that the drop occurred within the predetermined timeperiod subsequent to the scan. As discussed above with regard to thecorrect and incorrect medication indicators, drop tones are but one typeof indicator which may be used with respect to the entry sensor or dropsensor to indicate correct or incorrect drop or entry indicators. Othertypes of indicators may be used as discussed above with respect tocorrect and incorrect medication indicators.

In addition, as discussed previously with reference to FIG. 3A, theentry or drop sensor may be set up to ascertain whether the medicationwas dropped through the appropriate portion of the sensing fieldassociated with the correct time period. According to such a scenario, acorrect drop tone would be sounded if medication 12A were droppedthrough the light beams 122 associated with sub array 124 (FIG. 3A)which is associated with the time period corresponding to compartment50. However, when the medication is supposed to enter compartment 50, abad drop may be indicated by a bad drop tone if medication 12A isdropped through the light beams associated with sub arrays 126 or 128and the time periods associated with compartments 52 and 54. Inaddition, a bad drop tone may sound for a drop of medication 12A whichwas indicated to be the incorrect medication when scanned by sensor154A. Furthermore, a bad drop tone will be sounded when the plane ofdetection is broken when no scan has been previously performedindicating that a drug or medication should be dropped into drawer 14.Thus, any unauthorized object passing through the plane of detection,whether a medication, part of the technician's hand or otherwise, willbe deemed to be a bad drop and the bad drop tone will sound if acorresponding good medication scan has not first occurred.

If a pill or other object is dropped into the drawer or the plane ofdetection is broken without a good scan, the bad drop is recorded on apharmacist's error report so that the pharmacist is made aware of theerror during review of the report and will subsequently check the entiredrawer to verify the accuracy of the medications therein. Similarly, ifa bad scan tone is sounded due to a bad scan and the techniciannonetheless drops the wrong medication into the drawer (thus producing abad drop tone), a record of the error is produced on the pharmacist'serror report so that pharmacist may check the drawer. However, if a badscan tone is sounded and the medication is not dropped, the computerprogram clears the medication (typically within the short periodnormally allowed for dropping the medication) so that the correctmedication can be subsequently scanned without producing a record of anyerror since the incorrect medication never entered the drawer. Thescanning and dropping procedure utilizing sensors 154A-C and the dropsensor is repeated for each dose until all of the doses for a givenmedication are scanned and dropped. The computer program automaticallyadvances sequentially to the next medication (MED-1, MED-2, MED-3, etc.)for the repeated process of scanning and dropping until all themedications for a given patient have been scanned and dropped into theassociated drawer 14 within the appropriate compartments 50, 52 or 54associated with the time periods indicated by the computer program.Where no error occurs which produce an error report to the pharmacistfor a given drawer or container, the prescription may thus be filledwithout verification by the pharmacist and also administered to thepatient without verification by the pharmacist.

With continued reference to FIG. 10, the scanning and dropping processis described with more specific reference to the use of box 164 andsensor enablement device 146. One concept of the invention is to scanand drop various medications with a single hand in order to help reduceerrors which may be introduced by a second hand, including theinadvertent dropping of the medication prior to scanning or theinadvertent dropping of another medication or object into the drawerwhich would produce a bad drop tone. The invention provides two distinctways of providing for such a same hand scanning and dropping procedure.One way is by providing physical barriers to limit access to the spaceadjacent drawer 14, sensors 154 and light curtain 110. For instance, box164 may provide a barricade wall 166 along with the possible use of amanual access opening 178 through an access wall 172. Barricade wall 166helps to serve this purpose by providing a barricade between the naturalposition of the right and left hands of the technician which arerespectively indicated at the left hand finger 202 and right hand 204 inFIG. 10. When the user or technician faces containment device 18 andpositions right hand 204 for the purpose of scanning and/or droppingmedication 12A, the left hand 202 is naturally on opposite side ofbarricade wall 166 from right hand 204. Thus, an inadvertent movement ofleft hand 202 toward right hand 204 and the space above drawer 14 isgenerally blocked by barricade wall 166. In addition, access opening 178allows for the easy insertion of right hand 204 and may also be largeenough for the insertion of both hands, but nonetheless discourages theuse of both hands within interior chamber 180 of box 164. Another optionis to utilize a sensor enablement device 146 which must be activated byleft hand 202 to enable the use of sensors 154 which otherwise will notscan the medication. In the exemplary embodiment, the left hand finger202 must depress button 148 (typically closing an electrical circuit) ofdevice 146 to signal the computer program to enable the use of scanners154. If button 148 is released at any time, its internal spring biasesit automatically to its non-depressed inactivated position wherebyscanners 154 will not operate to scan the medication. This configurationthus also keeps the hands separated from one another so that only asingle hand is positioned over drawer 14. Although the activation ofdevice 146 may be used to signal the computer program to enable scanners154 as noted above, it may also control scanners 154 directly withoutinvolvement of the computer program by, for instance, turning on thescanning light or the like of the scanner.

FIGS. 11 and 12 represent the process of using caution labels forpartial tablets or pills and also for multiple pills per dose. Forinstance, computer 26 may display a patient medication profile requiringa dose which utilizes only a part of a pill or tablet or which utilizesmultiple pills or tablets. In this case, the computer program signalsprinter 31 (FIG. 1) to print a caution label to indicate that the doseincludes only a part of a pill or tablet or multiple pills. The labelalso includes a partial dose identifier 206 (FIG. 12) (or multiple pillsper dose identifier) such as a bar code or other machine readableidentifier. More particularly, identifier 206 of the caution label isshown on one side 208 (Side B) of a bag or package 210 in FIG. 12 whichin FIG. 11 faces and is scanned by sensor 154B to be acknowledged by thecomputer program. FIG. 11 thus shows a second side 212 (Side A) ofpackage 210 which faces away from sensor 154B and on which a medicationidentifier 214 is displayed which is indicative of the medication 12Bwithin package 210. It is noted that button 148 of sensor enablementdevice 146 remains depressed as indicated by Arrow F to enable sensor1548 to scan identifier 206. Once partial dose (or multiple pills perdose) identifier 206 has been scanned, package 210 is flipped over asindicated at Arrow G in FIG. 12 so that identifier 206 faces away fromsensor 154B and identifier 214 faces and is scanned by sensor 154B, asenabled by the continued depression of button 148. If labels 206 and 214are properly scanned, good scan tones are sounded respectively byspeakers 28 and the technician then drops package 210 through the planeof detection into intermediate compartment 52 of drawer 14. Aspreviously discussed with respect to the dropping of medication 12A inFIG. 10, package 210 interrupts light beams 122B shown in FIG. 12 toproduce a region 216 of no light beams. Once again, the lack ofreception of these light beams by receiving mechanism 114 signals thecomputer that a drop has occurred. If the sub arrays of receiver unit114 are used, the interrupted beams 122B are within sub array 126indicative of the time period associated with sensor 154B andcompartment 52 of drawer 14. As noted above, if such sub arrays areused, a bad drop tone may be sounded if the medication or package isdropped into the wrong compartment of drawer 14. Similarly, a bad scantone may be sounded if the technician attempts to scan the medication orpackage identifier with the wrong sensor 154.

Ultimately, the technician will fill drawer 14 with the variousmedications listed on the patient's medication profile (FIGS. 9A-9B) inaccordance with a medical prescription in order to fill theprescription. Typically, this is done unit dose by unit dose of variousmedications in a serial fashion. Usually a unit dose is signified by asingle pill, tablet or capsule although other unit doses such as thosein liquid form are also used, as discussed further below. As notedabove, a given prescribed dose may involve the use of a partial unitdose or multiple unit doses. Although a partial unit dose may beprescribed, the corresponding medication is typically verified in itsunit dose form along with the corresponding caution label discussedabove so that the unit dose may be broken or the like just prior toadministration to the patient. Where a prescribed dose includes two ormore unit doses of a given medication, that prescribed dose of multipleunit doses may be enclosed in a package such as package 210 in FIGS. 11and 12 whereby the identifiers on the package represent the multi-unitdose in contrast to a single unit dose. Especially where system 10 isused in a hospital setting or within another health care facility havingresident patients, the medications entering the patient drawer or otherpatient specific container typically will contain only medications whichhave been prescribed for a specific 24-hour period.

Once a given drawer 14 has been filled with the one or more medicationsindicated in the corresponding patient's profile as displayed on screen24 of computer 26, the computer program automatically unlocks lockingmechanism 160 (FIG. 13) by electromagnetically activating the solenoidthereof to move plunger 184 upwardly (Arrow J) to its unlocked position.It is noted that the computer program typically will not allow lockingmechanism 160 to be unlocked until drawer 14 has been properly filled inaccordance with the medical prescription or stocking order, which mayrequire that the pharmacist check the drawer if an error is identifiedduring the filling process. When mechanism 160 is unlocked, plunger 184is disengaged from locking surface 72 of crossbar 66 so that crossbarsand 66 and 68 may pass beneath plunger 184 as drawer 14 is manually slidforward (Arrow K) out of drawer-receiving space 90 of containment device18. As drawer 14 is being removed, the computer program will check tosee if the drop sensor is interrupted or broken for too long a period oftime, in which case an error tone is played and an error is recorded tothat effect to be printed on the pharmacist's error report. It is notedthat if the drop sensor is broken for too long a period at any time whendrawer 14 is in its secured position in device 18, a similar error toneis sounded and a similar error is recorded on the error report. Oncedrawer 14 is removed from device 18, it is reinserted in its locationwithin cart 16 (FIG. 1) and the drawer fill process is completed foreach of drawers 14 within cart 16.

Locking mechanism 160 is used in part to help ensure that drawer 14remains in its substantially stationary filling position throughout thefilling process. As previously noted, the movement of the plungerlocking mechanism 160 may send a signal to the computer program in orderto activate sensors 154. It may also send a signal simply indicatingthat a drawer has been inserted into the receiving space of containmentdevice 18 so that the computer program recognizes this and does notallow the removal of the drawer until the filling process is complete.However, a locking mechanism which secures the drawer within device 18may be replaced by another type of sensor which recognizes that drawer14 is in its filling position without locking the drawer into place. Forinstance, any suitable sensor may be used to signal the computer programthat a drawer has been inserted into its filling position and torecognize if the drawer has moved out of the filling position. Underordinary circumstances, drawer 14 will sit in a stationary positionabsent a force on the drawer supplied by the technician or otherwise.Thus, the computer program may be configured to go through the entirefilling process as long as this alternate sensor indicates that thedrawer or the container remains in its filling position. Thus, if thedrawer is moved out of the filling position and sensed by the sensor tothat effect, the computer program may be configured to produce an errorreport or to require that the filling of the drawer start over again.

As described above, a technician or other person may perform all thevarious tasks of the filling process. However, system 10 is alsoconfigured to be used with a robot which performs some or all of thetasks of the filling process. When a robot is used, it is in electricalcommunication with computer 26 whereby it may be controlled inaccordance with the computer program. The use of a robot or automatedmachinery may alter some of the processes discussed above, some of whichwill be noted below. The robot may be configured to remove patientdrawers 14 from cart 16 and to insert them into containment device 18.While the robot may be configured to perform an empty drawer check forinstance by turning the drawer upside down to empty it of any items, itmay be desired that a technician or other person perform the emptydrawer check alternately or in combination with any such function of therobot. This may be true for the drop area check as well. If the systemis configured without the need for a person to perform these checks, theinquiry or prompt for these checks which is typically displayed onscreen 24 (FIG. 9A) may be eliminated. Similarly, when a robot is usedto pick or select the medications from a storage location, scan themedications with sensors 154 and drop the medications into the drawer,the medication profile displayed on screen 24 or prompt or indicatorwhich would otherwise be communicated to the technician can beeliminated if desired. Such visual or audible indicators would not benecessary in order for the robot to operate properly. Instead, thecomputer program is typically configured to communicate directly to therobot to control its movements in accordance with the medication profileor stocking order. As previously discussed, pick sensors may be usedadjacent the storage locations or bins from which a medication is pickedto verify whether a given medication was picked from the locationspecified by the computer program. If the robot or technician picks amedication from the wrong storage location, the computer program mayindicate an error. Where the robot is used, it may be controlled toreturn the medication to the storage location and subsequently pick fromthe correct location. In the case of a technician or another person, apick error indicator which is typically visible or audible as previouslydescribed may be used to likewise inform the technician of the error sothat the medication can be returned to its storage location and theproper medication can be pulled from the correct storage location. Aswith the technician, the robot will scan the medication using one ofsensors 154 to properly identify the medication. If it is the correctmedication, then the robot will drop the medication into the drawerthrough the entry sensor. If not, the computer program is configured toprevent the robot from dropping the medication in order to present anerror report due to an incorrect entry into the drawer. In this case,the computer program may be configured to recognize the storage locationfrom which the incorrect medication has been picked, and to control therobot to return this medication to its proper storage location. If atechnician has scanned an incorrect medication, the computer program inaddition to producing an incorrect medication indicator may also providea visual or audible indicator instructing the technician where to returnthe medication. If a robot drops the incorrect medication, the computerwill record an error which will be produced typically in a report aspreviously discussed for the pharmacist. However, the visual or audibleincorrect entry indicator which is used with a technician or otherperson may be eliminated if desired when the robot is performing thistask. While the robot may be configured to function with box 164 suchthat a robotic arm of the robot may be inserted and withdrawn fromaccess opening 178 of access wall 172, certain portions or all of box164 may also be eliminated with the use of the robot. For instance,there may be no need for barricade walls 166 inasmuch as the use of arobot eliminates the concern of keeping the right and left hands of thetechnician separated from one another during the filling process. Inaddition, sensor enablement device 146 may be eliminated with the use ofthe robot. However, it may be desired to retain cover wall 174 or otherwalls of box 164 in order to help prevent unauthorized items fromaccidentally being dropped into drawer 14. Once a given drawer isfilled, the robot may be controlled to remove the drawer from containingdevice 18 and insert it into cart 16.

The process thus far has been described primarily with reference to thefilling of a patient drawer although as previously noted, system 10 maybe used for the filling of a storage or dispensing cabinet in order tofill a medication specific container with a specific medication in bulkin accordance with a stocking or re-stocking order. Although the fillingof such a bulk compartment may involve placing individual pills or otherunit doses of the same type one by one into a given bulk compartment,this process may also involve filling the bulk compartment with varioustypes of packaging which include multiple unit doses. For instance, suchpackaging may include a package which has individual units which areseparably connected to one another whereby the entire package may beused for stocking or re-stocking the medication compartment and theindividual units may be subsequently separated from one another prior toadministration of the medication. FIG. 13A shows an example of such amulti-dose package 213 which includes 10 unit dose packages 215 whichare individually separable from one another. More particularly, package213 includes a generally rectangular flat sheet 217 typically formed ofplastic or another suitable material which has various perforations orperforation lines 219 serving as tear lines such that sheet 217 may betorn along the lines in order to separate each unit dose package 215from the others. Holes 221 formed in sheet 217 are respectivelyassociated with corresponding unit dose packages 215 and medications orpills 12. A transparent bubble 223 extends outwardly from the sheet 17in communication with each hole, and a laminate layer 225 of foil, paperor other similar material is laminated on the opposite side of sheet 217so that pill 12 is contained within the space defined by transparentbubble 223 and the portion of layer 225 which covers the respective hole221. Pill 12 may be accessed by pushing on transparent bubble 223 toforce pill 12 through the portion of layer 225 covering hole 221. Wherea multi-dose package such as package 213 is used to fill a medicationcompartment, the computer program in response to reading identifier 198on package 213 may be configured to recognize that the package containsmultiple doses or pills 12, which in the exemplary embodiment is ten aspreviously noted. Alternately, the medication may be scanned and thetechnician may make an entry recognized by the computer program toindicate that a given number of pills or unit doses are associated withthe package 213. In any case, once the medication has been identified bythe appropriate sensor 154, package 213 is moved into patient drawer 14or other medication container whereby its entry is sensed by the entrysensor so that the computer program verifies the entry. The computerprogram may be configured to specify the number of multi-dose packagesneeded to stock or re-stock a medication compartment or for the fillingof a patient drawer. Thus, the computer program may be configured tocause the medication profile displayed on screen 24 to indicate, forexample, “three multi dose packages of Med-1” similar to the displaysshown in FIGS. 9A and 9B.

Once cart 16 has been filled, several computer generated reports aretypically produced which are to be reviewed by the pharmacist. Amongstthese is an “Orders Not Filled” report which indicates any medicationthat was missed during the fill of a given drawer 14. A “Fill ListErrors Report” is also produced to inform the pharmacist which drawersthe pharmacist needs to check by hand (visually) to ensure the accuracyof the medications therein. A “Fill List Detail” report is produced forreview by the pharmacist and lists every medication which was scannedfor each patient along with any errors. In addition, an “Orders WithoutDrug Location” report provides a list of all the drugs or medicationsthat were pulled or retrieved from the main pharmacy of the hospitalinstead of from the assigned pick areas which are represented by storagebins 20 in FIG. 1. Further, a “Pick Exception List” may be produced toindicate whether a given medication was picked from the correct pickingarea or storage bin 20.

The computer program is also configured to provide patient billing forthe various medications once all the drawers 14 on a cart 16 are filledby a one button click. Thus, the computer program is configured tointerface with the billing program of the pharmacy and/or hospital tocharge the patient for the medications. Any medications which wereplaced in the various patient drawers 14 and were not used may bereturned. These returned medications may be scanned by sensors 154 orthe like to determine the appropriate storage bin to which they shouldbe returned and also to update the billing by a single click to providecredit to the associated patient. In one embodiment, the medicationwhich is scanned for return is displayed on the computer screen for aspecific limited duration, at which time the program automaticallyclears the screen. The technician thus has sufficient time to read thedisplay in order to determine where the medication should be returned,but does not have to touch the computer in order to clear the screen.Thus, the technician can simply scan the medication, read the screen andput the medication away without further action whereby the computerprogram not only indicates where the medication is to be returned butalso automatically credits the patient's account. In the exemplaryembodiment, the return location is displayed on the screen for aboutthree seconds, although this duration may vary and is typically not morethan about ten seconds long. If the technician is returning severalmedications, the computer program may also be programmed such that ifthe return location for a first scanned medication is still on thescreen, the scanning of a second return medication may signal thecomputer program to clear the first return location from the screen anddisplay the second return location.

Referring now to FIGS. 14 and 15, an alternate sensor assembly isdescribed. This alternate sensor assembly includes medication sensors inthe form of a medication identifier camera 218 and an entry sensing ordrop sensing camera 220 which serves in part as an entry sensor or dropsensor. The embodiment shown in FIGS. 14 and 15 does not include thelight curtain or the like although the various options described withregard to the entry sensor or drop sensor of the previous embodiment mayalso be used in conjunction with the alternate sensor assembly. Some ofthe structure related to containment device 18 has been altered somewhatto accommodate the use of cameras 218 and 220. For instance, a bottomwall 74A is included which is analogous to wall 74 and is somewhatlonger in the axial direction, extending further toward second side 81away from drawer-receiving space 90. In keeping with this alteration, atransparent box 164A analogous to box 164 is included and is likewiseaxially longer than box 164. Thus, box 164 includes walls 166A, 168A and174A which are elongated in the axial direction to a greater degree thantheir counterparts of box 164. In addition, an elevated transparent wall96A includes a sidewall 108A which is axially longer than itscounterpart. These dimension changes accommodate camera 218, whichincludes a housing 222 which is mounted on the extended portion ofbottom wall 74A directly below sidewall 108A adjacent guide wall 80toward second side 81 of the device. Camera 218 further includes anaperture or lens 224 which faces upwardly toward sidewall 108A ofelevated wall 96A. Camera 218 is in electrical communication withcomputer 26 and an electric power source via an electrical wire 226.Sidewall 108A of elevated wall 96A includes a horizontal upper surfaceincluding a scanning location 236 which is typically directly above lens224 of camera 218. Camera 220 likewise includes a housing 228 and a lensor aperture 230 which faces downwardly and is typically positioneddirectly over the center of medication access opening 100. A support arm232 is connected to bottom wall 74A and housing 228 to support camera220 in this position. Camera 220 is in electrical communication withcomputer 26 and an electrical power source via an electrical wire 234.As shown in FIG. 15, lens 230 of camera 220 is substantially centeredabove the center compartment 52 of drawer 14 when drawer 14 is in itssecured position within containment device 18.

The operation of the alternate sensor assembly is described withreference to FIG. 15. Camera 220 is configured to perform the emptydrawer check and the drop area check to ensure that drawer 14 is emptyprior to the filling procedure and to ensure that the area around thedrawer is also free of medications or other loose objects. Thus, insteadof the technician providing this information, the computer program isconfigured to receive a signal from camera 220 indicating whether thedrawer is empty and whether the drop area is clear. If not, the computerprogram will not allow the filling procedure to proceed. Once it isdetermined that the drawer is empty and that the drop area is clear, thetechnician (or robot) will proceed with filling the drawer in a mannersimilar to that previously described. However, the technician or robotwill retrieve medications 12C from the appropriate storage bins andplace them at the scanning location 236 (Arrow L) with respectivemedication identifiers 198 facing downwardly. Camera 218 is focusedupwardly and is capable of sensing (dot-dash circle around location 236)the medication identifiers 198 through transparent wall 108A in order toidentify whether medications 12C are the correct ones. Good or bad scantones or other indicators are respectively produced in accordance withthe process previously described. Camera 218 is capable of scanning aplurality of medications simultaneously so that a given set ofmedications (typically making up a single prescribed dose) may be movedinto drawer 14 via a single motion of a technician's hand or roboticarm. Once medications 12C are identified as being the correctmedications, the technician or robot moves the medications into drawer14, for example into compartment 54 as shown at Arrow M by sliding thepills or medications along the upper surface of wall 108A or otherwise.Camera 220 senses that medications 12C have entered or been dropped intocompartment 54 as indicated at the dot-dash lines in compartment 54 andextending from camera 220. Camera 220 is thus not only capable ofdetermining whether the medications enter the drawer, but is alsocapable of determining whether the medications enter the propercompartment of the drawer. Good and bad entry tones or drop tones aresounded in accordance with the previous discussion.

Turning now to FIGS. 16-24, an additional modification to system 10 isdescribed. As will be readily understood by review of the figures, thestructure shown in FIG. 16 is substantially the same as that shown inFIG. 3 except for additional structure above elevated wall 96 which isused in further controlling the entry of medication or other objectsinto the patient drawer and thus helps to ensure 100 percent accuracy infilling the drawer so that a pharmacist need not verify the medicationswithin a given patient's drawer or other medication container. FIG. 16shows that light curtain 110 is used as the entry sensor or drop sensor,which was described in greater detail above. Presence sensing devicessuch as light curtain 110 vary in their ability to sense small objectswhich move quickly therethrough. The presence sensing devices which arecapable of ensuring 100 percent verification of such small objectspassing into the patient drawer are rather expensive. In an effort tominimize the cost of the present verification system, a less expensivelight curtain may be utilized. While the accuracy of such a lightcurtain for verifying objects entering the patient drawer is fairlyimpressive, it has been determined that some small stray objects havebeen able to pass through the light curtain without being detected.Although this may occur less than one in a thousand times, the object ofthe present invention is to ensure 100 percent verification of themedications entering the patient drawer or other container. To thateffect, the structure above elevated wall 96 has been added.

More particularly, this additional structure includes an openable andcloseable lid 238 which includes a transparent, rectangular, flat andhorizontal wall 240 which is spaced upwardly of wall 96 and supported inthis elevated position by a set of first legs 242 and a set of secondlegs 244 each of which is rigidly secured to and extends upwardly fromwall 96. First legs 242 are positioned on one side of access opening 100while second legs 244 are on the opposite side thereof. A hinge 246 ismounted the upper ends of first legs 242 with wall 240 adjacent its leftside attached to hinge 246 so that it is openable and closeable about ahorizontal axis 248 which extends rearwardly. A closed position of lid238 is shown in FIG. 16 and its open position is shown in FIG. 23. Anaccess opening or slot 250 is formed through wall 240 and is elongatedfrom adjacent the front end of wall 240 to adjacent its rear end. Slot250 has front and rear ends 252 and 254 defining therebetween a lengthwhich is substantially the same as that of access opening 100 and thethree compartments of drawer 14. Slot 250 also has left and right sides256 and 258 defining therebetween a width which is substantially lessthan that of access opening 100 and of the compartments of patientdrawer 14. In the exemplary embodiment, the width of slot 250 issubstantially less than half that of opening 100, typically less thanone third the width of opening 100 and typically on the order of aboutone quarter the width of opening 100. Slot 250 is positioned directlyabove and along the right side of opening 100 and drawer 14.

A medication guide wall 260 and a medication barrier wall 262 aresecured to and extend in a cantilevered fashion downwardly from thebottom of wall 240 respectively to the right and left of slot 250. Theupper end of guide wall 260 is secured to the bottom of wall 240 to theright of slot 250 and angles downwardly and to the left to a lowerterminal edge or end 264 whereby wall 260 provides a tapered uppersurface which angles downwardly and to the left directly below slot 250.Terminal end 264 is positioned to the left of the right side of accessopening 100 and the right side of drawer 14 although end 264 issubstantially closer to the right sides of opening 100 and drawer 14than to the respective left sides thereof. Barrier wall 262 is securedat its upper end to the bottom of wall 240 and extends verticallydownwardly therefrom to a lower terminal end 266 which is at aapproximately the same height as lower end 264. Barrier wall 262 isapproximately midway between the right and left of opening 100 anddrawer 14. Each of walls 260 and 262 extend continuously the full lengthof slot 250 and may extend beyond either end 252 and 254 thereof.

A cover 268 is provided which is slidable back and forth in order torespectively open and close slot 250. Although cover 268 is configuredfor sliding movement, it may pivot or move in any other suitable mannerbetween open and closed positions. In the exemplary embodiment, cover260 is transparent, rectangular, flat and horizontal, and is disposedimmediately above wall 240. The bottom of cover 268 is either closelyadjacent or slidably engages the top of wall 240 during its opening andclosing movement. Cover 268 has front and back edges 270 and 272 whichdefine therebetween a length which is preferably at least as long as andtypically longer than the length of slot 250. Cover 268 further includesleft and right edges defining therebetween a width which is at least aswide as and typically wider than the width of slot 250. The closedposition of cover 268 is shown in FIGS. 16, 17 and 19 while its closedposition is shown in FIGS. 20 and 21. In its closed or covered position,cover 268 preferably completely covers slot 250 with its right edge 276adjacent and to the right of right edge 258 of slot 250. Cover 268 maybe configured so that it does not completely cover slot 250 in theclosed position, but it should nonetheless prevent the passage ofmedications through slot 250 in the closed position. In the open oruncovered position of cover 268, slot 250 is completely uncovered toprovide access for medications to pass therethrough. In the exemplaryembodiment, cover 268 in its open position is disposed so that its rightedge 276 is to the left of left edge 256 of slot 250 whereby no portionof cover 268 is disposed directly above slot 250. Although slot 250 iscompletely uncovered when cover 268 is in the open position, this neednot be true as long as the opening provided via slot 250 is sufficientfor various medications to pass therethrough when the cover is in itsopen position.

Cover 268 further includes a pair of sleeves 278 adjacent its front end270 and a pair of sleeves 278 adjacent its rear end 272. Sleeves 278 aretubular members which receive therethrough parallel guide bars 280 oflid 238. Each guide bar 280 is spaced a short distance upwardly of thetop surface of horizontal wall 240 and supported at either end byrespective support posts 282 which are rigidly secured to and extendupwardly from wall 240. The cylindrical inner surfaces of sleeves 278slidably engage guide bars in order to guide the sliding movement ofcover 268 back and forth in a linear direction. Cover 268 is springbiased to its closed position by a spring member in the form of a coilspring 284 which circumscribes one of guide bars 280 between the leftrear post 282 and left rear sleeve 278. As shown in FIG. 16, spring 284is in a fully extended position with its left end abutting the left rearpost 282 and its right end abutting the left rear sleeve 278.

A powered cover drive mechanism or opening mechanism 286 is provided forpowering or driving the opening of cover 268. Mechanism 286 is inelectrical communication with computer 26 and under the control of thecomputer program of the verification system. In the exemplaryembodiment, drive mechanism 286 is electrically powered and typicallyincludes a solenoid. Mechanism 286 includes a drive arm 288 which issecured to cover 268 by a mounting bracket 290. In the exemplaryembodiment, drive mechanism 286 when electrically powered retracts drivearm 288 to move cover 268 from its closed position to its open position,thus overcoming the spring bias of spring 284. Although drive mechanism286 may be in the form of a motor which drives arm 288 in bothdirections, it may also drive only in one direction whereby spring 284serves as the drive mechanism for closing cover 268.

A cover open/closed sensor 292 is mounted on cover 268 in electricalcommunication with computer 26 via electrical wire 294. Sensor 292 isconfigured to sense whether cover 268 is open or closed and send acorresponding signal via wire 294 to the computer program run oncomputer 26. Any suitable sensor may be used. For example, sensor 292may be a sensor which senses a magnet or uses a magnet in order to movea switch such as a reed switch to open or close an electric circuit whenthe magnet is near the switch and whereby a signal is sent to thecomputer program indicating that the lid is either open or closed.Sensor 292 may also be a push-type or plunger-type switch in which aplunger, button or the like, is depressed when the lid is either open orclosed and not depressed when the lid is in the opposite position. A lidopen/closed sensor 296 (FIGS. 18-19) is mounted on elevated wall 96 viaone of first legs 242 and is in electrical communication with computer26 via electrical wire 298. Sensor 296 is in form of a plunger switchwhich includes a depressible plunger 300. Sensor 296 is thus configuredto sense whether lid 238 is in its open or closed position and to send asignal to computer 26 to that effect. As noted above with regard tosensor 292, lid sensor 296 may be any suitable sensor capable ofdetecting whether the lid is open or closed.

FIG. 18A illustrates a variation in which system 10 includes threepatient-specific time-specific containers 312A-C which are removablydisposed respectively within compartments 50, 52 and 54 of drawer 14.Each container 312 includes a bottom wall 314 and an annular side wall316 extending upwardly therefrom whereby walls 314 and 316 definetherewithin an interior chamber 318 which opens upwardly at a topentrance opening whereby containers 312 are configured to receivemedications. In the exemplary embodiment, side wall 316 includes foursubstantially flat rectangular walls which are adjacent and respectivelyparallel to the four side walls or dividers which define the respectivecompartment in which container 312 is disposed. When the flat walls ofcontainers 312 are thus positioned sufficiently close to thecorresponding walls of the compartment of drawer 14 so that medicationscannot fall into any space between the outer perimeter of side wall 316and the inner perimeter of the walls defining the associated compartmentof drawer 14. Containers 312 may be formed of substantially rigidmaterial and configured to stand on their own within compartments 50, 52and 54 or on another support surface such as a table or the like. Thus,for instance, the walls of each container 312 may be formed of metal,plastic or any other suitable material and may be open topped as shownor include lids or closures (as with a standard prescription pillbottle) which may be closed after the filling process to keep medicationfrom falling out and stray medications or other objects from enteringthe container. Containers 312 may be formed as reusable containers or asthe disposable containers. The generally rigid material noted above maybe used to form containers within either category. In addition,containers 312 may be formed of paper or the like in order to form cupsor bags which will generally tend to be used in a disposable fashion.Time period labels or indicators 320A-C are adhered respectively tocontainers 312A-C and correspond to the same time periods as previouslynoted with regard to time period labels 55A-C (FIG. 2) of respectivecompartments 50, 52 and 54. Each label 320 includes a human readabletime period which is the same as that shown on labels 55 respectively.Each label 320 also includes a machine readable code or identifier suchas a bar code, an RFID tag or the like which is used for identifying thepatient as well as the specific associated time period.

The operation of lid 238, cover 268 and the associated structure is nowdescribed with reference to FIGS. 20-24. Although transparent box 164(FIG. 3) is not shown in FIGS. 20-24, it will be understood that lid238, cover 268 and all of the associated structure are disposed withintransparent box 164 or a similar structure in the exemplary embodiment.FIGS. 20 and 21 show this operation with the use of yet anothermedication 12D which typically serves as a unit dose within a unit dosepackage 302. Medication 12D is typically different from medications12A-C, which are likewise typically different from one another. Unitdose package 302, like package 215 in FIG. 13A, is a typical medicationpackage which often includes a square flat sheet of plastic or othermaterial with a hole formed therethrough, a transparent bubble extendingoutwardly from the sheet in communication with the hole, and a layer offoil, paper or other similar material laminated on the opposite side ofthe plastic sheet whereby the user of the medication typically pushes onthe transparent bubble to force the pill through the foil, paper orother laminate in order for a patient to access the medication.

In any case, the technician or other person filling the prescription ofthe various medications which are to be placed into the patient specificdrawer 14 typically reads the specified medication on screen 24 ofcomputer 26 (FIG. 9A-9B) in order to determine the next medicationlisted or specified on the patient's medication profile or medicalprescription. Communicating the specified communication to thetechnician or a robot may be done by an alternate process as previouslydiscussed. The technician or robot then retrieves the medication fromthe appropriate storage location as previously described. With referenceto FIGS. 20 and 21, package 302 is manually or by automation positionedin front of medication identifier 154C, which reads the medicationidentifier thereon. As previously discussed, sensor 154C is associatedwith rear compartment 54 of drawer 14 and the associated time periodduring which the patient is to take medication 12D. As previouslydescribed, sensor 154C determines whether medication 12D is themedication which is highlighted or otherwise specified on the computerscreen in the same manner as previously discussed. If medication 12D isthe correct medication in accordance with the patient profile orprescription, computer 26 controls drive mechanism 286 to automaticallyopen cover 268 (Arrow N) in response to the movement of drive arm 288,whereby slot 250 is open and package 302 is dropped through slot 250(Arrow P) into rear compartment 54. Sensor 292 moves with cover 268 andsenses that cover 268 has moved to the open position. During the openingmovement of cover 268, sleeves 278 slidably engage guide bars 280 withleft rear sleeve 278 compressing spring 284 against left rear post 282.FIG. 21 further illustrates the movement of package 302 by thedownwardly pointing Arrows such that package 302 moves to the right anddownwardly away from sensor 154C and toward slot 250, through which itis dropped onto the angled surface of guide wall 260 so that package 302moves to the left and downwardly and into rear compartment 54. Barrierwall 262 helps prevent medications and unit dose packages frominadvertently being knocked out onto elevated wall 96 and thus notentering drawer 14. As FIG. 21 shows, package 302 moves downwardly belowthe lower terminal ends 264 and 266 of walls 260 and 262 to pass throughthe plane of detection of light beams 122 prior to entering compartment54. The entry sensor in the form of light curtain 110 thus detects theentry of package 302 into drawer 14 as previously discussed. Thecomputer program is typically configured to activate drive mechanism 286for just a few seconds in order to allow the technician or robot to dropthe medication through slot 250 into the drawer therebelow. The computerprogram either activates drive mechanism 286 to drive cover 268 back toits closed position or deactivates mechanism 286, for instance when itis a solenoid, whereby spring 284 drives cover 268 to its closedposition. In the exemplary embodiment, slot 250 typically remains openfrom about three to five seconds. Although this time period may vary,its duration is usually within the range of two to six seconds andtypically no more than six to ten seconds. This relatively short timeperiod thus allows the technician or robot to drop the medication intothe proper compartment and also minimizes the possibility that othermedications or stray objects may enter the patient drawer through slot250. Cover 268 thus normally remains closed except during theserelatively short time periods of being open in response to sensors 154identifying the correct medication.

Referring now to FIGS. 22-24, the operation of lid 238 is described ingreater detail. Lid 238 is configured primarily to allow for theplacement of various medications and their associated packages intodrawer 14 without passing through slot 250. More particularly, somepackages are difficult to move through slot 250 or are simply too largeto move therethrough. The computer program run by computer 26 is thusconfigured to allow for the opening of lid 238 without creating an errorsignal or error report to the pharmacist in certain circumstances. FIGS.22-24 illustrate the use of the verification system with yet anotherunit dose package 304 which contains a different medication 12E which isin liquid form and in particular is contained within a syringe 306 in apre-measured amount which makes up the unit dose of the medication. Thefigures show syringe 306 including a hypodermic needle although asyringe without such a needle may be used for instance to simplify thetaking of liquid oral medications. As with the previous medications, thecomputer program 26 highlights or otherwise specifies the name of themedication 12E on screen 24 of computer 26 to direct the technician topull the appropriate medication. Package 304 is positioned adjacentsensor 154C as previously discussed so that said sensor checks to see ifit is the correct medication. If it is the correct medication, thecomputer program gives the appropriate good scan tone or other correctmedication indicator and may indicate on the computer screen or via anaudible or visible signal that lid 238 may be manually opened.

As shown in FIG. 22, the right side of lid 238 is supported atop theupper ends of posts 244. To open lid 238, the technician simply manuallylifts lid 238 along its right edge so that wall 240 is lifted upwardlyand off of legs 244 as it pivots about axis 248 of hinge 246, (Arrow Qin FIG. 23). As lid 238 is lifted upwardly, plunger 300 is allowed tomove upwardly (Arrow R) under the spring bias of an internal springwithin sensor 296. The movement of plunger 300 upwardly thus creates asignal which is communicated to computer 26 that lid 238 is open. Thelifting of lid 238 is in accordance with the computer program in lightof the specific medication and thus does not produce an error report inresponse to the signal sent from sensor 296. An error report would beproduced in response to such a signal if lid 238 were opened at any timeduring the filling process without first having been authorized by thecomputer program in response to one of sensors 154 identifying amedication which accorded with a program specified medication of thesort which was intended to be placed in the patient drawer by way of theopen lid. Once lid 238 is open, the technician then moves package 306with medication 12E therein through the entrance or access opening 308which is created below the raised right side of lid 238 and intocompartment 54 of drawer 14. Entrance opening 308 thus provides accessto patient drawer 14 which is distinct from and larger than the accessprovided by access opening or slot 250. As with the previously discussedmedications, package 306 passes through the plane of detection of beams122 whereby the entry sensor senses the entry of package 306 into drawer14.

Once package 306 is in the proper compartment of drawer 14, lid 238 isthen lowered (Arrow S in FIG. 24) so that it is closed. The closing oflid 238 depresses plunger 300 of sensor 296, thereby signaling thecomputer program to that effect. The computer program may allow acertain limited time for lid 238 to be opened without producing an errorreport. Again, this is typically several seconds as discussed above inregard to the opening of cover 268. The opening and closing of lid 238may be automated, but is not necessary. It is further noted that thesystem may be configured so that cover 268 is simply manually opened andclosed instead of being driven in either direction by a drive mechanismsuch as mechanism 286 or 284. However it is preferred that cover 268 bebiased to its closed position. It is further preferred that the systemis set up so that the computer program can limit the amount of time thatslot 250 is open.

Referring now to FIG. 25, an alternate configuration is shown formarking a medication with a caution label which indicates a partialdose. For example, FIG. 25 shows a caution label 310 which is attacheddirectly to a medication 12F in the form of a pill wherein the cautionlabel 310 includes a bar code or other machine readable medicationidentifier as well as a human readable textual message which in thepresent example indicates “take half a tab”. It has been found thatapplying some partial dose caution labels to certain unit dose packagessuch as certain bags made it difficult to effectively scan the labels.Thus, the method of the present invention includes directly adheringcaution label 310 to a pill or the like with a layer of adhesive alongone side of label 310. Label 310 is removably attached to the pill andmay be simply manually peeled off prior to administration.

FIG. 26 illustrates an alternate entry sensor which comprises a scale322 which is in electrical communication with computer 26 via one ofwires 32. Scale 322 is configured for weighing drawer 14 and the variousmedications and/or medication packages as they enter drawer 14. AlthoughFIG. 26 shows entry sensor 110 as well, scale 322 may be used withoutentry sensor 110 in order to provide the sole entry sensor as controlledby the computer program. In order for scale 322 to function effectivelyas an entry sensor, it needs to be sufficiently sensitive to discernrelatively small weight changes when used with unit dose packages as istypically the case with system 10. In operation, the medication package302 or the medication will be scanned by the medication identifiersensor 154 as previously discussed. The pre-established weight of agiven medication or medication package is stored in a database which thecomputer program accesses in order to determine whether the medicationor medication package which enters drawer 14 is in accordance with thepre-established weight of said medicine or medicine package. If theweight as determined by scale 322 is within sufficient tolerance of theestablished weight, a correct scan indicator will be activated whereasan incorrect indicator may be activated if the determined weight is notwithin the pre-established tolerance of the pre-established weightwithin the database. Scale 322 can also be used in conjunction with, forexample, another entry sensor such as entry sensor 110 to provideadditional verification.

FIGS. 27 and 28 illustrate the operation of system 10 when usingcontainers 312A-C (FIG. 18A). FIG. 27 illustrates one of containers 312having been filled in various medications in a serial or sequentialmanner wherein said medications are indicated at 12D-G. The fillingprocess using containers 312 is the same as previously described exceptthat the medications enter containers 312 within compartments 50, 52 and54 instead of simply entering said compartments. Where sub arrays 124,126 and 128 (FIG. 3A) are used, they are respectively associated withsensing entry of medications or other objects into containers 312A-C.FIG. 28 illustrates the bedside dispensing and administration ofmedications in one of containers 312. More particularly, cart 16 isrolled from the pharmacy or other location into or adjacent thepatient's room. FIG. 28 illustrates that the hospital room or the likecontains a bed 324 for the patient 326, who is wearing a patientidentification bracelet 328 which includes a machine readable patientidentifier 330 such as a barcode or the like. System 10 may furtherinclude a portable scanner 332 which a nurse or other hospitalprofessional may carry or which may be onboard cart 16. As shown in FIG.28, the drawer 14 which is associated with patient 326 is opened andcontainer 312 is removed therefrom so that scanner 322 can scan the timeperiod label 320 thereon, which is associated with the patient as wellas the specific time period during which the medications withincontainer 312 are to be administered. Scanner 322 may also be used toscan patient identifier 330 so that the computer program can make acomparison to verify that patient 326 is indeed the patient who is totake the medications within container 312. If so, the nurse willadminister the medications from container 312 to patient 326. If not,then said medications will not be administered and additionalverification will be undertaken. This patient verification procedure ishelpful in light of the fact that patients are often moved from onehospital room to another. In addition, the use of container 312simplifies the administration of the medications associated with theassociated time period because scanner 332 merely needs to read label320 instead of independently reading each of the labels associated witheach medication within container 312. Due to the fact that system 10 hasalready verified all of the medications within container 312 andassociated them with label 320, the use of the time specific container312 eliminates this additional scanning of individual medications at thepoint of or just prior to administering the medication to the patient.

As previously discussed, containers 312 may be formed of substantiallyrigid material or flexible materials and may be reused or disposed ofafter the medications have been dispensed therefrom for administrationto the patient. The use of containers 312 in the form of paper cups is aconvenient way of administering the medications such that the nurse cansimply hand the paper cup to the patient so that the patient takes themedication therein so that the paper cup may be simply disposed ofthereafter. When the containers 312 are formed as paper or plastic bagsor the like, they may be sealed or generally closed in one manner oranother such that the nurse or patient may simply open the bag or tearit open in order to access the medications therein just prior toadministering the medication to the patient. Like the paper cups, thesebags are easily disposable.

FIGS. 29 and 30 illustrate an additional improvement in theadministration of medications which is particularly useful within ahospital setting. FIG. 29 illustrates a wheeled or rolling cart 334which is similar to cart 16 in that it includes wheels 34 and containsmultiple patient drawers 14 such that cart 334 may be used in the samemanner as cart 16 with respect to system 10 as previously described. Inaddition, cart 334 includes a bulk medication drawer 336 which isgenerally substantially larger than patient drawer 14 and includesmultiple bulk medication bins or compartments 338. Drawer 336 mayinclude lock engageable structure 62 or the like so that drawer may beselectively locked into cart 334. Each compartment 338 contains aspecific medication in bulk (i.e., multiple unit doses such as pills,capsules, etc.) wherein each compartment 338 contains in bulk adifferent or distinct medication, as indicated at numbers 340A-I. Thesemedications may be controlled or non-controlled, but are generally notscheduled controlled medications, which are high-risk medications. Eachcompartment 338 has its own medication label or identifier 342 whichincludes a human readable portion and a machine readable portion whichcorresponds to the specific medication 340A-I within respectivecompartment 338, as illustrated by the different medication referenceson each label, for example, “MED-1”, “MED-2”, etc.

In operation, cart 334 allows a nurse or other authorized individual toquickly access medications which may be dispensed on an as needed basisto the patient. The nurse can thus quickly access such over-the-countermedications from the nearby cart instead of having to return to acentralized location where these medications are conventionally storedin order to retrieve the same and bring them back to the patient. Moreparticularly, the nurse can use a scanner 332 to scan (FIG. 30) a label342 associated with the medications in the corresponding compartment 338to indicate a pill 344 or the like of a specific one of the medicationshas been removed from the associated compartment 338 to be administeredto the patient. The nurse will also have used scanner 332 to scanpatient identifier 330 on the patient's bracelet 328 (FIG. 28) wherebythe computer program makes the association between the given patient andthe medication pulled from the medication compartment 338 having thelabel 342 which was scanned in order to track which medication thepatient has taken as well as to automatically charge the patient'saccount for the medication.

FIG. 31 (FIG. 31A-31B) is a flow chart illustrating the overall processrelating to the use of system 10. As noted at block 345, a patient isadmitted to the hospital and the patient's pertinent informationincluding his or her identification is entered into a computer databasewhich is typically that of the hospital. Once examined by a doctor, thedoctor may prescribe medications as indicated at block 346, after whichthe pharmacist or doctor inputs the prescription into a computerdatabase which may be the hospital database or the database ofverification system 10. If the prescription is input into the hospitaldatabase, system 10 can access said database via an appropriateinterface. One or more doctors will prescribe medications for a varietyof patients for which the pharmacist or doctor also inputs the variousprescriptions. Especially in the setting of a hospital or similarhealthcare facility, the prescriptions typically specify specific timeperiods during which the medications are to be taken, such as a specific24-hour period which may include a portion of one or two calendar days,or a time period which is less than 24 hours. As shown in block 347, atechnician will log onto the computer of system 10 to access themedication verification program. The technician or robot will thenunlock and remove the patient drawer or other container from the rollingcart or cabinet and insert it into the containment device as noted atblock 348. The drawer is automatically locked to the containment devicein a secured fill position in which the drawer is ready to be filledwith medications prescribed for the patient associated with the draweror in accordance with a stocking order. Block 349 further indicates thatthe appropriate sensor reads the drawer label or pertinent identifier toestablish the patient associated with the drawer and the pertinentpatient-related information including medications. The computer programprompts the technician to perform an empty drawer check to make sure thedrawer is empty and also to check the drop area to search for and removeany foreign objects which might get knocked into the drawer if notremoved. The program then generates a medication profile for the givenpatient or stocking order and provides a storage location and dispensingtime period for each medication. As indicated at block 350, thetechnician or robot then picks the indicated medication from its storagelocation in accordance with the profile or order. As noted at block 351,the computer program will verify the medication as the technician scansthe medication with the appropriate medication ID sensor. In accordancewith whether the medication is determined to be the correct or incorrectmedication, the program is configured to provide a correct or incorrectindicator which communicates to the technician or robot whether themedication should be entered into the drawer or other container orcompartment which may be time-specific and patient specific ormedication specific. As noted at block 352, the technician or robot willthen enter the medication into the drawer or other compartment orcontainer, preferably only if it is the correct medication. The entrysensor confirms the entry of the medication and a correct or incorrectentry indicator is provided depending on whether the correct orincorrect medication entered the drawer. If there are pertinent errors,an error report will be generated by the program for review by thepharmacist, as indicated at block 353. As noted at block 354, the drawerfill is completed by repeating the previous steps in accordance with thecomputer program for all of the prescribed medications indicated in thepatient profile. The containment device is then automatically unlockedso that the technician or robot can remove the containment device andreinsert it into the rolling cart. As noted in block 355, the entireprocedure is repeated in order to fill all applicable containers in acabinet or drawers in a cart or a first set of carts which are typicallyused for delivering and dispensing medications the following day since asecond set of carts is being used during the day that the first set ofcarts is being filled. Although the process has been largely describedwith reference to hospital carts which are transported from the pharmacyto a nurses station or patient room, it is also noted that an individualmedication container such as previously discussed containers 312 (FIG.18a ) may be transported individually by hand separate from a cart,which often occurs when a patient enters the hospital and needs aninitial dose of medication prescribed after arrival. When the carts arerolled to or nearby a given patient room, a bedside verification processis carried out as indicated at block 356 by scanning the patientidentification bracelet and checking for a match between the identifiedpatient and a set of medications in the drawer/container to verify thatthe pertinent medications have been prescribed for the given patient.More particularly, the medication packages may be scanned individuallyor the container holding the medications can be scanned without thenecessity of scanning each medication individually in order to ascertainwhether the patient and the medications are a match. If so, themedications are administered to the patient, according to the timeperiod on the time specific container. Block 357 illustrates the processof using system 10 for the dispensing of medications. More particularly,a cart with bulk medication bins may be used by scanning the binmedication identifier and the patient ID bracelet and administering themedication so that the medication can be easily tracked for variouspurposes and so that medications can be dispensed from thede-centralized rolling cart. The process discussed with reference toFIG. 31 is described in greater detail at various places throughout thepresent application.

Thus, the medication verification system of the present inventionsubstantially decreases the amount of time that a pharmacist spendschecking for the accuracy of the medications within patient drawerswhile also providing a high degree of accuracy for the fillingprocedure. This system is conveniently configured for use with standardpatient drawers and thus does not require additional containers althoughas discussed above the system may also be used with containers otherthan patient drawers. The sensor assembly provides a mechanism forcorrectly identifying medications as well as a mechanism for determiningwhether the correct medication entered the drawer or other container.This system is also configured to eliminate or minimize inadvertententry of stray objects or incorrect medications and provides reportsindicating errors so that, amongst other things, the pharmacist maycheck any drawers that need verification. The computer program of thesystem is configured to interface with the host system computer programor computer programs of the hospital in order to provide communicationbetween the system of the present invention and the host system withregard to tracking and updating all orders and patients concerned. Inaddition, the interface between the present system and the host systemincludes a billing interface to facilitate the automated billing processnoted above.

In the foregoing description, certain terms have been used for brevity,clearness, and understanding. No unnecessary limitations are to beimplied therefrom beyond the requirement of the prior art because suchterms are used for descriptive purposes and are intended to be broadlyconstrued.

Moreover, the description and illustration of the invention is anexample and the invention is not limited to the exact details shown ordescribed.

The invention claimed is:
 1. A method comprising the steps of:determining with a medication identification sensor whether a firstmedication is a correct or incorrect medication; producing a correct orincorrect medication indicator respectively depending on whether thefirst medication is the correct or incorrect medication in accordancewith the step of determining; causing entry of the first medication intoa medication container after the step of producing; sensing the entrywith an entry sensor to verify that the first medication has entered thecontainer; further comprising, after the steps of determining,producing, causing and sensing, the steps of determining with amedication identification sensor whether a second medication is acorrect or incorrect medication; producing a correct or incorrectmedication indicator related to the second medication respectivelydepending on whether the second medication is the correct or incorrectmedication in accordance with the step of determining whether the secondmedication is a correct or incorrect medication; causing entry of thesecond medication into the container after the step of producing theindicator related to the second medication; and sensing the entry of thesecond medication with an entry sensor to verify that the secondmedication has entered the container; and further comprising the stepsof providing a containment device which defines a filling position,wherein the containment device includes a wall which has inner and outersurfaces and defines an access opening extending from the inner surfaceto the outer surface above the filling position, wherein the wallcarries a cover which is movable relative to the wall between an openposition in which medications may pass through the access opening intothe container and a closed position in which medications may not passthrough the access opening into the container; positioning the containerat the filling position under the wall and access opening by moving themedication container relative to the wall to insert the medicationcontainer into the filling position so that the access opening is abovethe medication container in the filling position; opening the accessopening by moving the cover from the closed position to the openposition while the container remains at the filling position; droppingthe first medication through the opened access opening into thecontainer to effect the step of causing entry of the first medication;closing the access opening, after the step of dropping and before thestep of determining whether the second medication is a correct orincorrect medication, by moving the cover from the open position to theclosed position; reopening the closed access opening after the step ofproducing the indicator related to the second medication by moving thecover from the closed position to the open position while the containerremains at the filling position; dropping the second medication throughthe reopened access opening into the container while the containerremains at the filling position to effect the step of causing entry ofthe second medication into the container; removing the container withthe first and second medications therein from the filling position bymoving the container relative to the wall; wherein the step ofdetermining whether the first medication is a correct or incorrectmedication comprises determining whether the first medication is acorrect or incorrect medication by reading a first machine readableidentifier connected to the first medication with a medicationidentification sensor mounted adjacent the wall and the access opening;the step of dropping the first medication comprises dropping the firstmedication with the first identifier connected thereto through theopened access opening into the container; the step of determiningwhether the second medication is a correct or incorrect medicationcomprises determining whether the second medication is a correct orincorrect medication by reading a second machine readable identifierconnected to the second medication with a medication identificationsensor mounted adjacent the wall and the access opening; and the step ofdropping the second medication comprises dropping the second medicationwith the second identifier connected thereto through the reopened accessopening into the container.
 2. The method of claim 1 wherein the step ofdropping the first medication comprises releasing the first medicationfrom one of a person's hands while the first medication is above theopened access opening; and the step of dropping the second medicationcomprises releasing the second medication from one of the hands whilethe second medication is above the reopened access opening.
 3. Themethod of claim 1 wherein the medication identification sensor used todetermine whether the first medication is a correct or incorrectmedication faces toward a space above the access opening; the step ofreading the first machine readable identifier occurs while the firstmedication is in the space above the access opening; the step ofdropping the first medication comprises releasing the first medicationwhile the first medication is in the space above the opened accessopening; the medication identification sensor used to determine whetherthe second medication is a correct or incorrect medication faces towardthe space above the access opening; the step of reading the secondmachine readable identifier occurs while the second medication is in thespace above the access opening; and the step of dropping the secondmedication comprises releasing the second medication while the secondmedication is in the space above the reopened access opening.
 4. Themethod of claim 3 wherein the step of reading the first machine readableidentifier occurs while holding with one of a person's hands the firstmedication in the space above the access opening; the step of releasingthe first medication comprises releasing the first medication from oneof the hands; the step of reading the second machine readable identifieroccurs while holding with one of the hands the second medication in thespace above the access opening; the step of releasing the secondmedication comprises releasing the second medication from one of thehands.
 5. The method of claim 3 wherein the step of reading the firstmachine readable identifier occurs while holding with a robotic arm thefirst medication in the space above the access opening; the step ofreleasing the first medication comprises releasing the first medicationfrom the robotic arm; the step of reading the second machine readableidentifier occurs while holding with the robotic arm the secondmedication in the space above the access opening; the step of releasingthe second medication comprises releasing the second medication from therobotic arm.
 6. The method of claim 1 wherein the first machine readableidentifier is connected to a package containing a number of unit dosesof the first medication, wherein the number represents a plurality ofthe unit doses; after determining that the first medication is a correctmedication, making an entry of the number of unit doses with a computerinput mechanism so that the entry of the number is recognized by acomputer program to indicate that the number of unit doses is associatedwith the package; and wherein the step of dropping the first medicationcomprises dropping the package containing the number of unit dosesthrough the opened access opening into the container by releasing thepackage while the package is above the opened access opening.
 7. Themethod of claim 1 wherein the second machine readable identifier isconnected to a package containing a number of unit doses of the secondmedication, wherein the number represents a plurality of the unit doses;after determining that the second medication is a correct medication,making an entry of the number of unit doses with a computer inputmechanism so that the entry of the number is recognized by a computerprogram to indicate that the number of unit doses is associated with thepackage; and wherein the step of dropping the second medicationcomprises dropping the package containing the number of unit dosesthrough the reopened access opening into the container by releasing thepackage while the package is above the reopened access opening.
 8. Themethod of claim 1 further comprising: providing a plurality of storagebins each containing a plurality of medications; picking with a roboticarm or one of a person's hands the first medication from one of thestorage bins; while holding the picked first medication with the roboticarm or one of the hands, moving the robotic arm or one of the hands awayfrom the one of the storage bins from which the first medication waspicked to adjacent the access opening; wherein the step of reading thefirst machine readable identifier comprises reading the first machinereadable identifier while holding with the robotic arm or one of thehands the picked first medication adjacent the access opening; after thestep of reading the first machine readable identifier, dropping thefirst medication from the robotic arm or one of the hands while therobotic arm or one of the hands is above the access opening to effectthe step of dropping the first medication through the opened accessopening into the container; after the step of dropping the firstmedication, moving the robotic arm or one of the hands away from theaccess opening to adjacent one of the storage bins in which the secondmedication is stored; picking with the robotic arm or one of the handsthe second medication from the one of the storage bins in which thesecond medication is stored; while holding the picked second medicationwith the robotic arm or one of the hands, moving the robotic arm or oneof the hands away from the one of the storage bins from which the secondmedication was picked to adjacent the access opening; wherein the stepof reading the second machine readable identifier comprises reading thesecond machine readable identifier while holding with the robotic arm orone of the hands the picked second medication adjacent the accessopening; after the step of reading the second machine readableidentifier, dropping the second medication from the robotic arm or oneof the hands while the robotic arm or one of the hands is above theaccess opening to effect the step of dropping the second medicationthrough the reopened access opening into the container.
 9. The method ofclaim 8 wherein the one of the storage bins from which the firstmedication was picked is different from the one of the storage bins fromwhich the second medication was picked.
 10. The method of claim 1further comprising: providing a box defining an interior chamber whichextends over the wall; picking the first medication with a robotic armor one of a person's hands from a location outside the box; whileholding the first medication with the robotic arm or one of the hands,inserting the robotic arm or one of the hands into the box; dropping thefirst medication from the inserted robotic arm or one of the hands toeffect the step of dropping the first medication through the openedaccess opening into the container; after dropping the first medication,withdrawing the robotic arm or one of the hands from the box; pickingthe second medication with the withdrawn robotic arm or one of the handsfrom a location outside the box; while holding the picked secondmedication in the robotic arm or one of the hands, reinserting therobotic arm or one of the hands into the box; dropping the secondmedication from the reinserted robotic arm or one of the hands to effectthe step of dropping the second medication through the reopened accessopening into the container; and after dropping the second medication,withdrawing the robotic arm or one of the hands from the box.
 11. Themethod of claim 10 wherein the location from which the first medicationwas picked is a first storage bin outside the box; and the location fromwhich the second medication was picked is a second different storage binoutside the box.
 12. A method comprising the steps of: determining witha medication identification sensor whether a first medication is acorrect or incorrect medication; producing a correct or incorrectmedication indicator respectively depending on whether the firstmedication is the correct or incorrect medication in accordance with thestep of determining; causing entry of the first medication into amedication container after the step of producing; sensing the entry withan entry sensor to verify that the first medication has entered thecontainer; further comprising, after the steps of determining,producing, causing and sensing, the steps of determining with amedication identification sensor whether a second medication is acorrect or incorrect medication; producing a correct or incorrectmedication indicator related to the second medication respectivelydepending on whether the second medication is the correct or incorrectmedication in accordance with the step of determining whether the secondmedication is a correct or incorrect medication; causing entry of thesecond medication into the container after the step of producing theindicator related to the second medication; and sensing the entry of thesecond medication with an entry sensor to verify that the secondmedication has entered the container; and further comprising the stepsof providing a containment device which defines a filling position,wherein the containment device includes a wall which has inner and outersurfaces and defines an access opening extending from the inner surfaceto the outer surface above the filling position, wherein the wallcarries a cover which is movable relative to the wall between an openposition in which medications may pass through the access opening intothe container and a closed position in which medications may not passthrough the access opening into the container; positioning the containerat the filling position under the wall and access opening by moving themedication container relative to the wall to insert the medicationcontainer into the filling position so that the access opening is abovethe medication container in the filling position; opening the accessopening by moving the cover from the closed position to the openposition while the container remains at the filling position; droppingthe first medication through the opened access opening into thecontainer to effect the step of causing entry of the first medication;closing the access opening, after the step of dropping and before thestep of determining whether the second medication is a correct orincorrect medication, by moving the cover from the open position to theclosed position; reopening the closed access opening after the step ofproducing the indicator related to the second medication by moving thecover from the closed position to the open position while the containerremains at the filling position; dropping the second medication throughthe reopened access opening into the container while the containerremains at the filling position to effect the step of causing entry ofthe second medication into the container; removing the container withthe first and second medications therein from the filling position bymoving the container relative to the wall; providing a plurality ofstorage bins each containing a plurality of medications; picking with arobotic arm or one of a person's hands the first medication from one ofthe storage bins; before the step of dropping the first medication,moving the picked first medication with the robotic arm or one of thehands away from the one of the storage bins from which the firstmedication was picked to adjacent the access opening; after the step ofdropping the first medication, moving the robotic arm or one of thehands away from the access opening to adjacent one of the storage binsin which the second medication is stored; picking with the robotic armor one of the hands the second medication from the one of the storagebins in which the second medication is stored; before the step ofdropping the second medication, moving the picked second medication withthe robotic arm or one of the hands away from the one of the storagebins from which the second medication was picked to adjacent the accessopening; after the step of dropping the second medication, moving therobotic arm or one of the hands away from the access opening; providinga box defining an interior chamber which extends over the wall; whereinthe storage bin from which the first medication was picked is outsidethe box; wherein the storage bin from which the second medication waspicked is outside the box; wherein the step of moving the picked firstmedication away from the one of the storage bins from which the firstmedication was picked to adjacent the access opening comprises insertingthe robotic arm or one of the hands into the box through an openingformed in a wall of the box; dropping the first medication from theinserted robotic arm or one of the hands to effect the step of droppingthe first medication through the opened access opening into thecontainer; wherein the step of moving the robotic arm or one of thehands away from the access opening to adjacent the one of the storagebins in which the second medication is stored comprises withdrawing theinserted robotic arm or one of the hands from the box through theopening formed in the wall of the box; wherein the step of moving thepicked second medication away from the one of the storage bins fromwhich the second medication was picked to adjacent the access openingcomprises reinserting the robotic arm or one of the hands into the boxthrough the opening formed in the wall of the box; dropping the secondmedication from the reinserted robotic arm or one of the hands to effectthe step of dropping the second medication through the reopened accessopening into the container; and wherein the step of moving the roboticarm or one of the hands away from the access opening after the step ofdropping the second medication comprises withdrawing the robotic arm orone of the hands from the box through the opening formed in the wall ofthe box.
 13. The method of claim 12 wherein the step of dropping thefirst medication comprises releasing the first medication from one ofthe hands while the first medication is above the opened access opening;and the step of dropping the second medication comprises releasing thesecond medication from one of the hands while the second medication isabove the reopened access opening.
 14. The method of claim 12 whereinthe step of moving the robotic arm or one of the hands while holding thepicked first medication with the robotic arm or one of the handscomprises moving the robotic arm or one of the hands away from the oneof the storage bins from which the first medication was picked to aspace above the access opening; the step of reading the first machinereadable identifier comprises reading the first machine readableidentifier while holding with the robotic arm or one of the hands thepicked first medication in the space above the access opening; the stepof dropping the first medication comprises dropping the first medicationfrom the robotic arm or one of the hands while the robotic arm or one ofthe hands is in the space above the access opening; the step of movingthe robotic arm or one of the hands after the step of dropping the firstmedication comprises moving the robotic arm or one of the hands awayfrom the space above the access opening to adjacent the one of thestorage bins in which the second medication is stored; the step ofmoving the robotic arm or one of the hands while holding the pickedsecond medication with the robotic arm or one of the hands comprisesmoving the robotic arm or one of the hands away from the one of thestorage bins from which the second medication was picked to the spaceabove the access opening; the step of reading the second machinereadable identifier comprises reading the second machine readableidentifier while holding with the robotic arm or one of the hands thepicked second medication in the space above the access opening; the stepof dropping the second medication comprises dropping the secondmedication from the robotic arm or one of the hands while the roboticarm or one of the hands is in the space above the access opening.
 15. Amethod comprising the steps of: determining with a medicationidentification sensor whether a first medication is a correct orincorrect medication; producing a correct or incorrect medicationindicator respectively depending on whether the first medication is thecorrect or incorrect medication in accordance with the step ofdetermining; causing entry of the first medication into a medicationcontainer after the step of producing; sensing the entry with an entrysensor to verify that the first medication has entered the container;further comprising, after the steps of determining, producing, causingand sensing, the steps of determining with a medication identificationsensor whether a second medication is a correct or incorrect medication;producing a correct or incorrect medication indicator related to thesecond medication respectively depending on whether the secondmedication is the correct or incorrect medication in accordance with thestep of determining whether the second medication is a correct orincorrect medication; causing entry of the second medication into thecontainer after the step of producing the indicator related to thesecond medication; and sensing the entry of the second medication withan entry sensor to verify that the second medication has entered thecontainer; and further comprising the steps of providing a containmentdevice which defines a filling position, wherein the containment deviceincludes a wall which has inner and outer surfaces and defines an accessopening extending from the inner surface to the outer surface above thefilling position, wherein the wall carries a cover which is movablerelative to the wall between an open position in which medications maypass through the access opening into the container and a closed positionin which medications may not pass through the access opening into thecontainer; positioning the container at the filling position under thewall and access opening by moving the medication container relative tothe wall to insert the medication container into the filling position sothat the access opening is above the medication container in the fillingposition; opening the access opening by moving the cover from the closedposition to the open position while the container remains at the fillingposition; dropping the first medication from one of a person's handsthrough the opened access opening into the container to effect the stepof causing entry of the first medication; closing the access opening,after the step of dropping and before the step of determining whetherthe second medication is a correct or incorrect medication, by movingthe cover from the open position to the closed position; reopening theclosed access opening after the step of producing the indicator relatedto the second medication by moving the cover from the closed position tothe open position while the container remains at the filling position;dropping the second medication from one of the hands through thereopened access opening into the container while the container remainsat the filling position to effect the step of causing entry of thesecond medication into the container; removing the container with thefirst and second medications therein from the filling position by movingthe container relative to the wall; providing a box defining an interiorchamber which extends over the wall; picking the first medication withone of the hands from a location outside the box; while holding thepicked first medication in one of the hands, inserting the one of thehands holding the picked first medication into the box through anopening formed in a wall of the box; dropping the first medication fromthe inserted one of the hands to effect the step of dropping the firstmedication through the opened access opening into the container; afterdropping the first medication, withdrawing the inserted one of the handsfrom the box through the opening formed in the wall of the box; pickingthe second medication with one of the hands from a location outside thebox; while holding the picked second medication in one of the hands,inserting the one of the hands holding the picked second medication intothe box through the opening formed in the wall of the box; dropping thesecond medication from the inserted one of the hands holding the pickedsecond medication to effect the step of dropping the second medicationthrough the reopened access opening into the container; and afterdropping the second medication, withdrawing from the box the one of thehands which dropped the second medication through the opening formed inthe wall of the box.
 16. The method of claim 15 further comprising:providing a plurality of storage bins each containing a plurality ofmedications; picking with one of the hands the first medication from oneof the storage bins; moving the picked first medication away from theone of the storage bins from which the first medication was picked toadjacent the access opening; after the step of dropping the firstmedication, moving the one of the hands which dropped the firstmedication away from the access opening.
 17. The method of claim 16further comprising: picking with one of the hands the second medicationfrom one of the storage bins; moving the picked second medication awayfrom the one of the storage bins from which the second medication waspicked to adjacent the access opening; after the step of dropping thesecond medication, moving the one of the hands which dropped the secondmedication away from the access opening.
 18. The method of claim 17wherein the one of the storage bins from which the first medication waspicked is different from the one of the storage bins from which thesecond medication was picked.